Financial Aid Office · 197 Franklin Street, Auburn, NY 13021

Auburn 315-255-1743 ext. 2470 · Fulton 315-592-4143 ext. 3004 · FAX 315-252-2185

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 # __________________________________________________________

C-Number #  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: From__________________________to________________________


1.  The host institution certifies that the above referenced student is enrolled for the period indicated.

2.  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.

3.  Cayuga Community College agrees to accept the credits earned at the Host Institution.

4.  Cayuga Community College agrees to provide payment to the student, if eligible, for the appropriate

     period of time.

5.  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                                                   Host Institution

Signature                                                                                   Signature

Title_________________________________                      Title________________________________

                                                                                                Address _____________________________



Date________________________________                                    Date________________________________