Forms Manager

I Want to Change My Payment Plan

This Payment Agreement and Disclosure Statement is for College of Saint Benedict and Saint John’s University students.

Please read the Payment Agreement and Disclosure Statement before completing this form.

School

	CSB (undergrad)
	SJU (undergrad)
	CSB Graduate Nursing
	School of Theology

Payment Plan Choice

	Standard Payment Plan (Due date for Fall-Aug 10, Due date for Spring-Jan 10)
	Deferred Payment Plan (Due dates for Fall-Aug 10th, Sept 10th, Oct 10th, Nov 7th. Due dates for Spring-Jan 10th, Feb 10th, Mar 10th, Apr 7th)

Last Name

Middle Initial

First Name

Street Address

City

State

Zip Code

Telephone Number

Name of Parent/Guardian if Student is under the age of 18. By submitting this form, the Parent/Guardian is acknowledging receipt of the Notice to Co-Signor.

After submitting, scroll to the bottom of the page and print your responses for your records.