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.
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.
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