Financial Responsibility Agreement

Student Information

Student ID Number

Student First Name:

Student Last Name:

Social Security Number (last 4 ending in -)

Permanent Address

Country

Street

City

Region

Postal Code

Primary Phone Number

Birthdate

Student's Driver License Number or Identification Number

Email Address

Spouse's First Name

Spouse's Last Name

Which program are you enrolling in?

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent Type

Country

Street

City

Region

Postal Code

Agreement

This financial responsibility agreement is binding until rescinded in writing by the University. I, the undersigned student, and guarantor (if any), for value received understand and agree to the following terms and conditions:

I am personally responsible for payment of all debt incurred. I certify that I am at least 18 years of age as of the date of the signature on this contract.

My student account constitutes a financial obligation between me and LCU and reflects a balance I owe for educational benefit and constitutes an educational loan that may not be dischargeable in bankruptcy proceedings pursuant to 11 U.S.C. § 523 (a) (8).

My student account balance is payable in full according to the policy stated in the current LCU catalog which is available online at www.LCU.edu. A late fee in the amount disclosed in the Student Financial Policies section of the LCU online catalog will be added to my account balance for non-compliance. If it becomes necessary to enforce payment of this account, I agree to reimburse LCU the fees of any collection agency, which may be based on a percentage at a maximum of 50% of my debt, and all costs and expenses, including reasonable attorney fees, which LCU may incur in such collection efforts. This agreement shall be interpreted in accordance with and pursuant to the laws of the state of Texas, and I agree that venue for any suit regarding these matters referred to herein shall be exclusively in Lubbock County, Texas.

I agree that LCU retains a security interest in ALL transcripts, diplomas, certificates, and letters of recommendation, or grade reports, which will not be released until all debts are fully paid. I agree that withdrawal or expulsion from LCU DOES NOT relieve me of my financial obligations for payment of tuition and fees. LCU may prevent future registration until all my financial obligations have been met.

A fee will be charged by INSTACHEK for each returned check I issue or endorse to LCU.

I authorize Lubbock Christian University and its agents, representatives, attorneys, and contractors (including collection agencies) to contact me through my mobile phone, home phone and email, including by way of text, automated message calls or auto dialer.

I agree that my delinquent account may be reported to one or more of the national credit bureaus. I agree and authorize LCU to use my social security number for internal and external credit reporting and collection purposes for all charges incurred against this account.

I have read this agreement and understand it. By clicking the ‘accept terms and register’ button, I consent to this agreement, and agree to pay the University my outstanding balance, plus fees and costs according to the terms set forth above.

If you do not agree to the above, will not be able to schedule classes. You may navigate away from this screen or close your browser.

In lieu of signature, please type in your full legal name