GOVERNORS STATE UNIVERSITY  
SUMMER 2013 PAYMENT PLAN AGREEMENT FORM  

 I hereby acknowledge and agree to the following:

    If I register for classes from April 12 through May 25, 2013, I will pay my total semester balance as follows:

• A $20 non-refundable payment plan charge will be assessed on all accounts not paid in full by the first installment date.
• Unpaid account balances will result in my name being placed on the University hold list, which will prevent future registrations, release of transcripts, and denial of other student services.
• Account balances not paid by the installment date are subject to a $100 late fee, may be disclosed to credit reporting organizations, assessed collection costs, litigation costs, court costs, or attorney fees incurred by the University in collection of amounts due.
• I realize that I am liable for unpaid tuition and fees unless I officially drop within the 100% refund period. Failure to attend classes does not constitute an official withdrawal.
• Failure to have met prior payment plan obligations may prohibit me from entering into a payment plan with the University for future terms.