Payment Plan Authorization I, the undersigned participant, agree to be charged installments for the total Beyond Access program fee. I agree to the amounts stated on the payment schedule below to the University of Connecticut. I understand that if I discontinue participation, I will remain responsible for the remaining balance. Name(Required) First Last Your UConn Email Address(Required) PeopleSoft Number(Required)Length of Payment Plan(Required)Payment plan installments are offered based on date of authorization (e.g. pre-semester enrollment offers a maximum 4-5 payments and mid-semester enrollment offers 2 payments).5 Months4 Months3 Months2 MonthsBA Track(Required)Select your BA Track with 5 Months of Payments Track I - 5 Payments of $400 = $2000 FLEX I - 5 Payments of $490 = $2450 Track II - 5 Payments of $600 = $3000 Track III - 5 Payments of $790 = $3950 BA Track(Required)Select your BA Track with 4 Months of Payments Track I - 4 Payments of $500 = $2000 FLEX I - 4 Payments of $612.50 = $2450 Track II - 4 Payments of $750 = $3000 Track III - 4 Payments of $987.5 = $3950 BA Track(Required)Select your BA Track with 3 Months of Payments Track I - 3 Payments of $666.67 = $2000 FLEX I - 3 Payments of $816.67 = $2450 Track II - 3 Payments of $1000 = $3000 Track III - 3 Payments of $1316.67 = $3600 BA Track(Required)Select your BA Track with 2 Months of Payments Track I - 2 Payments of $1000 = $2000 FLEX I - 2 Payments of $1225 = $2450 Track II - 2 Payments of $1500 = $3000 Track III - 2 Payments of $1975 = $3950 Fee Schedule I agree to pay the installments on the first of every month for the duration of the length of the selected payment plan. *If the first falls on a weekend, the payment will be processed on the next business day. Fall Spring July 1st December 1st August 1st January 1st September 1st February 1st October 1st March 1st November 1st April 1st This fee will be added directly to my fee bill and will cover the cost of my participation in the Beyond Access Program for the given semester This payment plan is interest free. Charges will be applied directly to student bursar accounts and payment is due within 10 calendar days of each posting. I understand that if any payment is late, I will be charged additional fees per the Bursar Office late fee policy. Questions regarding payment can be directed to the Bursar Office via email Bursar@uconn.edu or phone 860-486-4830. For additional information on payment options, please visit Payment Options | Office of the Bursar Cancellation Policy If a student chooses to withdraw from the program or determines that they must withdraw from the University after the first day of classes, and prior to the start of the fifth week of classes, the Center will reduce the remaining balance of your payment plan according to the Beyond Access refund policy. For those cancelling enrollment in the Beyond Access Program, you will still be responsible for a portion of the program fee. If you withdraw during the first four calendar weeks, you will be responsible for the applicable program amount listed below. If you withdraw at any point during: the 1st calendar week of the semester, you are responsible for 10% of the total program cost. the 2nd calendar week of the semester, you are responsible for 40% of the total program cost. the 3rd or 4th calendar week of the semester, you are responsible for 50% of the total program cost. Those students who, at the time of cancellation, have paid more than their applicable percentage listed above, will be administered a refund according to the Beyond Access Refund Policy. The refund will be initiated after written confirmation of the request to withdraw has been received. No balance reductions will be offered after the conclusion of the 4th calendar week of the semester. If you feel that your situation warrants special consideration, you can appeal the decision per the instructions stated in the Beyond Access Refund Policy.Acknowledgement(Required) I acknowledge that I have read, understood, and have received a copy of this form.Acknowledgement(Required) I acknowledge that entering my name below acts as my signature and binds this agreement.Signature(Required)If you are over 18, please sign your name. If younger than 18, please have a parent or guardian sign.Date(Required) MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. MENUProgram Fees: Fall and Spring Semester Program Fees: Winter and Summer Financing, Payment Plans & Scholarships