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Employer Reimbursement Deferment Form

This form should be completed prior to the payment deadline of each semester. Submissions after the payment deadline will be subject to a $100 late payment fee. Your payment will be deferred until the 4th Friday of the following semester, at which time you are responsible for submitting payment for the full amount of your tuition and fees. For further explanation of this program contact the Business Office at 757.352.4050, 877.850.8434 or busoff@regent.edu.

* required field
 
* First Name:
Middle Initial:
* Last Name:
 
* Email:
* Home Phone:
* Work Phone:
* Company Name:
 
* Term:
Student ID:
 
* Amount to be deferred: $
NOTE: Be sure to include the $45.00 deferment fee
 
Comments:

I agree to submit payment in full by the 4th Friday of the next semester. I understand that in the event my payment is not received on this date, I will be dropped from all courses in which I an enrolled at that time and will be assessed a $100 late payment fee. I also understand that Regent University reserves the right to revoke my tuition deferment privileges if I fail to comply with the stipulations of this agreement. I also understand that if I withdraw from courses after the 100% or 50% refund periods in a given semester, I am still obligated to make payment in full for my outstanding balance by the published deferment/deadline date, regardless of forfeiting tuition reimbursement from my employer.
 
* I agree to this statement:
(please type your signature)