Application - Deferment of Tuition Payment

Application - Deferment of Tuition Payment

Name First Last
Student ID (6 digit ID number)
Email Address:
Date of Request:
(Must be submitted by the end of the Add/Drop period in order to be considered for the current semester.)
  I request that payment of tuition be deferred as I qualify for the tuition benefit under my employer's policy. Deferment is applicable to:

Fall Semester

Spring Semester

Summer Semester
Required: Year

Number of Credits

Total Cost $
I understand and agree that if, for any reason, my employer refuses payment, I take leave of my present place of employment, or if I withdraw from my classes after the 100% cancellation period, I will be responsible to Bloomsburg University for the immediate and full payment of all tuition due.

By submitting this application, if Bloomsburg University bills my employer directly, I authorize Bloomsburg University to release my grades to my employer.

Affidavit - I certify that all of the information provided by me is true, complete and correct. I understand the information provided in the form is subject to verification by Bloomsburg University. Note: This box must be checked to submit form.