Deferral Authorization Form

Your organization must cover at least 50% of all tuition and fees to be eligible for the Deferral Program. Undergraduate courses are calculated based upon an average of the current in-class and online tuition rate. Graduate courses are calculated based upon the current graduate tuition rate.

Under all circumstances, the student is solely responsible for all tuition and fees due. Upon approval for the deferral payment option, Bellevue University will defer payment due dates of tuition and fees 45 days from the end of the class/term. Account balances owed to Bellevue University will be taken out of financial aid disbursements prior to receipt of any refund. Approval for the Deferral Program is contingent upon completion of this document.

Student Name:

Student ID:

Email:

Email Confirmation:

Employer:

My organization is affiliated with EdAssist as a tuition assistance provider:

Yes
No

Annual dollar amount of tuition assistance reimbursement authorized by my organization:

Reimbursement Schedule:

I am reimbursed by Calendar Year
I am reimbursed by Fiscal Year

Reimbursement based upon:

Beginning of class
End of class

Number of credits I plan to enroll into this academic year:

I am utilizing Financial Aid at Bellevue University during this time period:

Yes
No

By checking this box I certify that I have read, understand, and agree to the terms and conditions of Bellevue University's Deferral Program. I also understand that participation in the Deferral Program is voluntary and the terms and conditions are not contingent upon the receipt of grades or reimbursement by my tuition assistance provider.

Deferral Authorization Form

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