Financial Aid Office ● 197 Franklin St. • Auburn, NY  13021

   315-255-1743 ext. 2470 • 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.  Please complete the following form.  Once you have entered the necessary information online, you will need to print the form, provide all required signatures and forward it to the Host Institution.


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 # _________________________________________________________________


MyCayuga 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.   I agree to provide Cayuga Community College with all academic transcripts generated as a result of this 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 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__________________________