Text Box:  This form is for students registered and enrolled with the Kuskokwim Campus only. Forms sent to other College of Rural and Community Development campuses or sent to Kuskokwim Campus from outside its service region will be discarded. Deferred fees allow students to make installment payments for charges due to the University. Eligibility is restricted to students who do not have any outstanding debt to the University of Alaska. NAME UAF ID DATE OF BIRTH PERMANENT ADDRESS PHONE NUMBER REFERENCES List references who live at different addresses. Include parent or closest relative – and your employer, if applicable. NAME ADDRESS PHONE NUMBER RELATIONSHIP NAME ADDRESS PHONE NUMBER RELATIONSHIP NAME ADDRESS PHONE NUMBER RELATIONSHIP FINANCIAL AID [ ] Check here if payment will be made by financial aid. IDENTIFY FUNDING SOURCE HERE Verified by Financial Aid Officer Initial and Date By signing this form, I agree that the proceeds of any financial aid will be used to pay all of my deferred fees at the time of disbursement of the financial aid regardless of the deferred fee payment due dates. I understand that a processing fee of $50.00 will be added to my bill. I understand that my registration is not complete and valid until all fees are paid. I understand my enrollment may be cancelled and all transcripts and grades withheld if I fail to pay all financial obligations to the University of Alaska Fairbanks as agreed. I promise to pay UAF the total amount due this semester as stated below, even if I do not receive the financial aid for which I have applied. I agree to make payments according to the schedule. The balance is due in three equal installments (Feb 15., Mar. 15, Apr. 15, 2010) Late payments are charged $35.00 Student Signature Date Please attach this form to your registration with your minimum down payment of $150.00 plus $50 processing fee for a total payment of $200. All previous balances must be paid in full before registration can be accepted.

YUKON KUSKOKWIM DELTA STUDENTS

DEFERMENT APPLICATION
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