Consortium Agreement

As allowed in Part 668.19, student Assistance General Provisions, and Part 690.9, Pell Grant Program, Code of Federal Regulations, this Consortium Agreement is entered into between Cayuga Community College (home institution) and ________________ (host institution) for financial Assistance to the student named below.

This completed form must be on file with all concerned parities before the start of instruction and before Cayuga Community College will disburse any financial aid funds.

Payment of tuition and fees at the host institution will be the responsibility of the student.

To be completed by Student

Name of Student ____________________________

Social Security #

Banner ID # C _

Home Address

_______________________________

Academic Year Period of Enrollment: From_to

I have received the approval of my academic advisor for the course(s) covered by this Consortium Agreement.

Signature________________________ Date

To be completed by Host Institution

Pell Grant Cost of Attendance for Academic Year                  $_________

Institutional Cost of Attendance for Consortium Period           $_

Tuition Charge for Consortium Period                                    $_

Number of Credits    Length of Enrollment Period

Dates of Enrollment: Fromto__________

Certification

The host institution certifies that the above referenced student is enrolled for the period indicated.
The host institution agrees that it will NOT pay the student a Pell Grant and/or any campus based funds and that it will NOT certify a Stafford or Ford Federal Direct Loan during the Consortium period. Further, the Host institution agrees that, if award, it will inform Cayuga Community College if the student withdraws before the end of the period of attendance.
Cayuga Community College agrees to accept the credits earned at the Host Institution.
Cayuga Community College agrees to provide payment to the student, if eligible, for the appropriate period of time.
Cayuga Community College agrees to monitor the student’s program pursuit and satisfactory academic progress and to be responsible for disbursing funds to the student, and for administering the appropriate refund policy.

Cayuga Community College Signature	Host Institution Signature
____________________________________	___________________________________
Title________________________________	Title________________________________
	Address_____________________________
	____________________________________
	____________________________________
Date________________________________	Date________________________________

Cayuga Community College

Consortium Agreement

To be completed by Student

Name of Student __________________________________________________________

To be completed by Host Institution