Last Name:
First Name:
Middle:
Other Last Names Used
Year(s) and semester(s) for name(s) listed
Street Address:
City:
State:
Zip:
EMail:
Phone:
Date of Birth:
Last four digits of SSN: (optional)
Are you currently a student at AIC?
Have you previously taken classes at AIC?
If yes, when:
How did you hear about AIC?
Please select at least one Course Number . Section [Course Name ] Credits
1)
2)
3)
4)
5)
6)
Payment:
AIC will send you a bill for the course(s) and payment is due upon receipt. If payment is not received by the end of the add/drop period for the course, you will be dropped from the course for non-payment.
By submitting this form, I agree to abide by AIC regulations including those governing payment of tuition and withdrawal from class.
Collection Policy: I understand and accept if I fail to pay my student account bill or any monies due and owing AIC by the scheduled due date, and fail to make acceptable payment arrangements to bring my account current, AIC may refer my account to a collection agency. I further understand if AIC refers my student account balance to a third party for collection, whether an attorney or collection agency, I will be responsible for any costs (including but not limited to collection fees) associated with attempting to collect the monies due and owing. I understand a collection fee will be assessed and will be due and owing in full at the time of the referral to the third party. The collection fee will be calculated at the maximum amount permitted by applicable law but not to exceed 50 percent of the amount outstanding. For purposes of this provision, the third party may be a debt collection company or an attorney. If a lawsuit is filed to recover an outstanding balance, I shall also be responsible for any costs associated with the lawsuit such as court costs or other applicable costs. Finally, I understand that my delinquent account may be reported to one or more of the national credit bureaus. By signing this document I am agreeing to this policy.
ELECTRONIC SIGNATURE CONSENT:
You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the American International College. You are also confirming that you are the student authorized to provide the data in this document. By electronically signing documents, you agree to all the terms and conditions of such documents as they exist on the date of your E-Signature.
Date:
September 7, 2024
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