Office of Student Financial Aid
1 Drexel Drive – Box 40
New Orleans, Louisiana 70125-1098
(504) 520-7835 ~ FAX (504) 520-7906
Consortium Agreement Request
Student’s Name:
ID #
I, ______________________________________, request Xavier University to enter into a
Consortium Agreement on my behalf with ___________________________________________,
which is the host institution that I will study during the  Fall ______  Spring ______ and/or
 Summer ______ semester(s).
I acknowledge that I have met with the Dean or an eligible representative of my Department, and
have been granted approval to take _____ credit hours that will transfer back to Xavier
University of Louisiana. The courses I am scheduled to enroll in at the host institution are as
follows:
Course Number
Course Title
Number of
Credit Hours
______I am aware that I must retain enrollment for the proper required hours in order to qualify
for Federal Student Aid.
______I am aware that I must maintain Satisfactory Academic Progress (SAP), which will be
monitored by my home school.
______I authorize my host institution to release all information to Xavier University (my home
institution).
______I am requesting Xavier University to process my financial aid and disburse funds
accordingly.
________________________________________________
Student’s Signature
______________________
Date