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Luther College 2020-2021 Monthly Payment Plan Worksheet and EFT Agreement A new application must be completed each year (Due July 1, 2020)

Student's Name__________________________________________________ Student ID#____________________ ***********************************************************************************************************************************

STEP 1 CHARGES Please use the following schedule to calculate your charges.

Incoming Student This Term? Incoming Student This Term?

Fall Semester Tuition $22,500.00 Spring Semester Tuition $22,500.00 Technology Fee $200.00 Technology Fee $200.00 Co-Curricular Activity Fee (CAF) $117.50 Co-Curricular Activity Fee (CAF) $117.50

Fall Semester Room ______________ Spring Semester Room ______________

Fall Semester Board ______________ Spring Semester Board ______________ Music Lessons- Applied $550/credit hr; Class $235 ________________ Music Lessons- Applied $550/credit hr; Class $235 ______________ Other Fees- (Parking Permit $220, etc) ________________ Other Fees- (Extra Credit Hr- $803.50/credit

________________

Health and Wellness Fee $105.00 Health and Wellness Fee $105.00

Fall Semester Total Charges ________________ Spring Semester Total Charges ________________

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STEP 2 CREDITS List credits using your offer of financial aid from the Financial Aid Office. Examples: scholarships, net loans, grants, work study. Fall Semester - Spring Semester

$ $

$ $

$ $

$ $

$ $

$ $

$ $

Fed Dir Subsidized Ln (Net Amt, round up) $ Fed Dir Subsidized Ln (Net Amt. round up) $

Fed Dir Unsub Loan (Net Amt, round up) $ Fed Dir Unsub Loan (Net Amt, round up) $

Work Study Plan (from #3 on WSP application) $ Work Study Plan (from #3 on WSP application) $

Outside Payment (529 Plan, Other family member, etc) $ Outside Payment (529, Other family member, etc) $

Fall Semester Total Credits $ Spring Semester Total Credits $

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STEP 3 AMOUNT OF MONTHLY PAYMENT

Fall Semester Total Charges (Step 1) $_________________ Spring Semester Total Charges (Step 2) $__________________

Minus Fall Semester Total Credits (Step 2) - _________________ Less Spring Semester Total Credits (Step 3) - __________________

I refuse EFT* + _________________ I refuse EFT* + _________________

Total Fall Semester Monthly Payment Plan = $_________________ Total Spring Semester Monthly Payment Plan = $_________________

� 5 Fall Semester Payments ÷ 5 � 5 Spring Semester Payments ÷ 5 Due July 10th – November 10th $_______________ Due December 10th – April 10th $________________

� 4 Fall Semester Payments ÷ 4 Due August 10th – November 10th $_______________

� 4 Spring Semester Payments ÷ 4 Due January 10th – April 10th $________________

Your first EFT will occur on the 10th of the month for plans processed on or before the 1st of that month. Otherwise, your first EFT will occur on the 10th of the following month. This EFT will include all back payments.

Add $110 for Lifetime Academic Transcript and Commencement Fees

Add $110 for Lifetime Academic Transcript and Commencement Fees

(Please note: We appreciate your assistance in completing this worksheet fully. Incomplete worksheets will be returned.) Page 2

Step 4: Bank Information (bank must be located within the United States) Student ID#____________________

�Checking Account �Savings Account

_____________________________________________ _____________________________________________ Name of Financial Institution Name of Acccount Owner(s)

_____________________________________________ _____________________________________________ Bank Acccount Number A.B.A. Routing Number

_____________________________________________ _____________________________________________ Bank Phone Number Accountholder Daytime Number

I have read the information provided on the information page. I wish to participate in Luther College's monthly payment plan and will follow the above payment schedule. I am aware of my responsibilities as a participant of the monthly payment plan. I authorize Luther College and the financial institution named above to initiate entries to my checking/savings account. This authority will remain in effect until the last monthly payment plan payment has been processed. I can stop payment of any entry by notifying Luther College by the 1st of the month prior to the scheduled EFT.

�*I refuse to use an EFT. I understand a $100 non-refundable setup fee will be added to each semester for NON-EFT plans. I also understand that if any payment is not received by the scheduled due date, a late charge of 1% of the past due amount will be assessed to my student account.

______________________________________________________________ ________________________________ Account Owner Signature Date

To Do: 1. You should complete

o Monthly Payment Plan (this form)o Work Study Payment Agreement (Fill out

application if you used for your calculations)2. Scan and e-mail items to finserv@luther.edu, or mail

Office for Financial Services Luther College

700 College Drive Decorah, Iowa 52101-1058

3. Luther College will mail a confirmation letter andupdated statement to the home address on file

Additional Information

Charges You may include music lessons ($550 per credit hour/$235 per class lesson) and off-campus board plans when setting up your monthly payment plan. Extra credit hours, music lessons, and other charges may be billed at a later date. You will then receive an email indicating you have a balance due.

Credits If you have not received your new financial aid award letter, you may use last year's as an estimate. When you receive an updated offer, you must request a revised monthly payment plan from our office (Office for Financial Services).

Monthly Payment The fall monthly payment plan information will appear on the account after you are billed for fall semester charges. Spring semester plan payment information will appear in December after you are billed for spring semester charges.

Loans Federal loans should be reduced by the origination fee. Federal Direct Stafford Subsidized or Unsubsidized (1.066%) and Federal Direct PLUS (4.264%)

Insufficient Funds If an EFT is unsuccessful due to insufficient funds or a closed account, the student account will be charged $25. Then, a second EFT attempt will occur on the 20th of the month. If this second EFT is also unsuccessful, the student account will be charged an additional $25 fee and the plan will be canceled and the balance will be due immediately.

Questions? Please call the Office for Financial Services at 563-387-1015 or 800-458-8437 ext. 1015, if you need moreinformation. We’re here to help.