FAX: 904-256-7206
Phone: 904-256-7080
JACKSONVILLE UNIVERSITY
GRADUATE CORPORATE REIMBURSEMENT PROGRAM
ENROLLMENT FORM
IN ORDER FOR YOUR ENROLLMENT TO BE COMPLETED, THIS FORM MUST BE
SUBMITTED WITH PROOF OF EMPLOYMENT
(please “black-out” any sensitive information, such as social security number, etc.)
AND DOCUMENTATION OF YOUR EMPLOYER’S TUITION REIMBURSEMENT POLICY.
A non-refundable deferment fee in the amount of $100 per Fall/Spring/Summer semester(s) will be
billed to your student account; payment is due by the fifth day of the semester. Payment may be made
online via WebAdvisor. Tuition and fees are due by the 36th day following the end of the 8-week or 16week terms of enrollment. For deadlines, please refer to the web at
http://www.ju.edu/controller/Pages/Important-Dates.aspx.
Please note that if you submit this form, you have elected corporate reimbursement as your payment
type and you are required to have all tuition and fees paid by the published corporate reimbursement
due date(s). If you request to be removed from the corporate deferment program, you will not be able
to add this option back to your account status unless under special circumstances (i.e. job change, HR
policy change, etc.).
It is the students’ responsibility to initiate payment; this includes the $100 deferment fee. If you do not
pay the remaining balance by the due date, your account will be considered delinquent. In such
instances, Jacksonville University has the right and may employ any or all of the following actions in
order to collect unpaid student account balances: using written, electronic, or verbal means of contact
as the law allows, including, but not limited to, contact by manual calling methods, prerecorded or
artificial voice messages, emails, and/or automated telephone dialing systems, contact by telephone at
any telephone number associated with the account, currently or in the future, including wireless
telephone numbers, and authorization to record telephone calls regarding the account in assurance of
quality and/or other reasons. Failure to pay a student account by the published deadline(s), may result
in the account being placed with a collection agency and/or for legal action. If such action(s) is/are
taken, students will be required to pay all collection fees (up to 33%) & costs, attorney fees & costs,
and/or any other fees/costs incurred as the result of the collection of any amount not paid.
By signing below, I ______________________________________________ acknowledge the following:
(print name & student ID)
-
I understand that any amount not covered by my employer under the Corporate
Reimbursement plan is my responsibility;
I understand that if I have not made payment on or by the payment deadline(s), the Controller’s
Office may take collection action pursuant to the terms indicated above;
I understand that if I do not pay my balance on or by the payment deadline(s), I will lose the
privilege of the Corporate Reimbursement program as my payment type for future semesters.
Student Signature: ______________________________________
Revised 2/26/14
Date: ____________________