Please print and complete this application, then mail it to:

Heartland ECSI c/o Wheeling Jesuit University TPP Application
PO Box 1278
Wexford, PA 15090

If you need help completing this form, please contact ECSI toll free at 866-927-1438.

Student Information

Student ID Number:
___________________________________________________________
Name (First MI Last):

 ___________________________________________________________
Address 1:

 ___________________________________________________________
Address 2:

 ___________________________________________________________
City/State/Zip:

 ___________________________________________________________
Email:

 ___________________________________________________________
Home Phone:

 ___________________________________________________________
Work Phone:

 ___________________________________________________________
Fax Phone:

 ___________________________________________________________
Cell Phone:

 ___________________________________________________________

Person Financially Responsible
Name (First MI Last):

 ___________________________________________________________
Address 1:

 ___________________________________________________________
Address 2:

 ___________________________________________________________
City/State/Zip:

 ___________________________________________________________
Email:

 ___________________________________________________________
Home Phone:

 ___________________________________________________________
Work Phone:

 ___________________________________________________________
Fax Phone:

 ___________________________________________________________
Cell Phone:

 ___________________________________________________________

Tuition Payment Plan
Select a plan: Select One
  Description Months Fee Start Date End Date Sign Up By
12 Month Plan (T1112) 12 $50.00 05/01/2011 04/01/2012 07/25/2011
10 Month Plan (T1110) 10 $50.00 07/01/2011 04/01/2012 09/25/2013
5 Month Fall Plan (T11F5) 5 $35.00 07/01/2011 11/01/2011 9/25/2011
5 Month Spring Plan (T11S5) 5 $35.00 12/01/2011 04/01/2012 02/25/2012

Student Status
Tuition: Select One
Academic Year ($24,650.00)
One Semester Only ($12,325.00)
 
Housing: Select None or One
Sara Tracy - Double - Annual ($4,030.00)
Sara Tracy - Double - Semester ($2,015.00)
Sara Tracy - Single - Annual ($5,690.00)
Sara Tracy - Single - Semester ($2,845.00)
McHugh - Double - Annual ($4,030.00)
McHugh - Double - Semester ($2,015.00)
McHugh - Single - Annual ($5,690.00)
McHugh - Single - Semester ($2,845.00)
Campion - Double - Annual ($4,120.00)
Campion - Double - Semester ($2,060.00)
Campion - Single - Annual ($6,090.00)
Campion - Single - Semester ($3,045.00)
Thomas Moore - Double - Annual ($4,410.00)
Thomas Moore - Double - Semester ($2,205.00)
Thomas Moore - Single - Annual ($6,530.00)
Thomas Moore - Single - Semester ($3,265.00)
Kirby - Double - Annual ($4,750.00)
Kirby - Double - Semester ($2,375.00)
Kirby - Single - Annual ($7,050.00)
Kirby - Single - Semester ($3,525.00)
Ignatius - Double - Annual ($4,990.00)
Ignatius - Double - Semester ($2,495.00)
Ignatius - Single - Annual ($7,400.00)
Ignatius - Single - Semester ($3,700.00)
Steenrod - Double - Annual ($4,990.00)
Steenrod - Double - Semester ($2,495.00)
Steenrod - Single - Annual ($7,400.00)
Steenrod - Single - Semester ($3,700.00)
 
Meal Plan: Select None or One
225 Meals & 100 Flex Dollars * ($4,968.00)
225 Meals & 100 Flex Dollars * ($2,484.00)
175 Meals & 100 Flex Dollars ($3,910.00)
175 Meals & 100 Flex Dollars ($1,955.00)
125 Meals & 100 Flex Dollars ($2,860.00)
125 Meals & 100 Flex Dollars ($1,430.00)
100 Meals & 200 Flex Dollars ($2,540.00)
100 Meals & 200 Flex Dollars ($1,270.00)
70 Meals & 100 Flex Dollars ** ($1,700.00)
70 Meals & 100 Flex Dollars ** ($850.00)
50 Meals & 150 Flex Dollars ** ($1,700.00)
50 Meals & 150 Flex Dollars ** ($850.00)
 
Notes:
* Required for all Freshman
** Meal Plan for commuters only


Mandatory Fees: (Select all that apply)
New Student Fee *** ($200.00)
Technology Fee - Academic Year ($460.00)
Technology Fee - One Semester Only ($230.00)
Activity Fee - Academic Year ($260.00)
Activity Fee - One Semester Only ($130.00)
Recreation Fee - Academic Year ($120.00)
Recreation Fee - One Semester Only ($60.00)
Health Fee - Academic Year ($150.00)
Health Fee - One Semester Only ($75.00)
Auto Registration ***** ($150.00)

Notes:
*** New Student Fee is required only for your first semester of school at Wheeling Jesuit University.
***** If student will not have a car on campus a waiver form must be completed to remove charge from account. See below to remove fee from TPP calculations.


Optional Fees: (Select all that apply)
Additional Fees
Graduation Fee (Degree Certification) ($260.00)

Semester Charges
Science Lab - First Class ($215.00/class)
Science Lab - Second Class ($215.00/class)
Science Lab - Third Class ($215.00/class)
Science Lab - Fourth Class ($215.00/class)
Nursing Fee Fall Semester ($576.00/semester)
Nursing Fee Spring Semester ($576.00/semester)
Clinical Science Fee Fall Semester ($510.00/semester)
Clinical Science Fee Spring Semester ($510.00/semester)
Professional Writing Lab - First Class ($100.00/class)
Professional Writing Lab - Second Class ($100.00/class)
Professional Writing Lab - Third Class ($100.00/class)
Athletic Training Fee ($155.00/class)


Parking Permit Waiver
Having a vehicle on campus is a privelege. All vehicles (motorcycles, cars, trucks, etc.) must be registered. All students will be billed for a parking decal. Stop by the Safety & Security Office to pick up your new decal. You may waive your parking fee if you do not have a vehicle on campus. This must be done at the Safety & Security Office by September 4, 2011. Issuing citations to unregistered vehicles will begin on September 8, 2011.

Please check this box to remove the Parking Permit fee indicating you have completed and submitted the Parking Permit Waiver directly to the Wheeling Jesuit University Safety & Security Office. (-$150.00)

Financial Aid:
(as it appears on your award letter. Do not include Work Study.)
Your award letter-includes loan amounts offered to you. All loans require paperwork which must be completed to apply for the loan funds. Include in the calculation below only those loans for which you intend to apply. If you do not intend to apply for loans offered on your award letter, do not include them below. If you have questions about loan types or amounts, please contact the Financial Aid Office at Wheeling Jesuit University. If you apply for loans that are denied, you are responsible for the amount of the loan. You may contact ECSI and adjust your contract by that amount.


Federal Subsidized Stafford Loan:
______________________
Federal Unsubsidized Stafford Loan:

 ______________________
Federal Plus Loan:

 ______________________
Federal Perkins Loan:

 ______________________
Additional Loans, Grants and Scholarships:

 ______________________


Deposits

Direct Payments to WJU:
______________________


Payment Plan Totals

Total Tuition and Fees:
______________________
(-) Less Financial Aid:

 ______________________
(-) Less Deposits:

 ______________________
Total Amount to Finance:

 ______________________ (Tuition and Fees minus Financial Aid and Deposits)
Monthly Payments:

 ______________________ (Total Amount to Finance divided by number of months in selected plan)
Application / Participation Fee:

 ______________________
First Payment †:

 ______________________ (Includes months past due and application/participation fee)
† - The application fee is due immediately. If the plan has not yet started, your first monthly payment is not due until the first due date.


Billing and Payment Information
Please sign me up for Electronic Bills
Electronic Bills replace paper bills, provide 100% of the same information, are archived for up to 10 years, and are available within minutes of preparation. When an electronic bill is prepared, you will receive an Email notifying you to return to our web site and review your billing statement.

Complete your payment options below.
Automatic Payments from Checking/Savings

You can make each future payment automatically from your checking or savings account. To do so, please check the box below and fill in the following information. If you are required to make a payment now, you will be given the opportunity to do this after submitting the application.
I would like to sign up for automatic payments
Account Holder Name: __________________________________________
Account Type: Checking Savings
ABA/Routing Number: __________________________________________
Account Number: __________________________________________
I (we) hereby authorize Educational Computer Systems, Inc. to initiate debit entries to my (our) account in the entity named above ("institution"), and I (we) authorize the institution to accept and to debit the amount of such entries to my (our) account. A one-time debit shall be made to cover the application fee and any past due payments. A debit shall be made each month equal to the amount due for that month's payment.