Billing Worksheet The payment plan is available for the Fall 2024 and Spring 2025 semesters only. If you owe a past due amount for a previous semester, you must contact the Student Financial Services Office. Note: DO NOT ENTER $0.00 IN ANY DOLLAR AMOUNT FIELD. If a field does not apply, please leave blank. "*" indicates required fields Name First Last GCC student ID# ChargesThe current term is Current Term ChargesAnticipated CreditsInsuranceIf you plan to waive your insurance charges your waiver form must be completed by the first day of classes for the current term. I plan to waive my insurance charges I have already waived my insurance charges I am not being charged for insurance Student Health InsuranceFinancial AidEnter amount of financial aid funds shown on your signed award letter. Must have been awarded aid by the due date of bill.Tuition WaiversEnter total amount of any tuition and/or fee waivers you expect to receive. Official waiver documentation must be submitted to the Bursar's Office.Private ScholarshipsEnter total amount of any private scholarships awarded to you. Scholarship award letter(s) must be submitted to Bursar's Office.In-House GrantsEnter total amount of any in-house grants awarded to you. Do not include grants awarded by the Financial Aid Office.Brief description of grant(s)* Third-Party PaymentsEnter total amount to be paid by a third party. Purchase order or written commitment to pay must be submitted to Bursar's Office.Balance DueThis is only an estimated balance as of today's date. If any of your charges change due to added or dropped classes, or if your anticipated credits adjust for any reason, you must complete this worksheet again.Amount DueYou have missed the deadline to enroll in GCC's payment plan. Your balance is due immediately.Enroll in payment plan?* Yes No Payment PlanIf you are not paying your bill in full by the due date, you must sign up for the payment plan and make your first payment along with the fee. In addition, if you have applied for financial aid and have not been awarded by the due date, you must sign up for the payment plan and continue to make regular payments until your financial aid is awarded and you have enough aid to pay your balance. In order to participate in the payment plan, a one-time $35 non-refundable fee applies per semester. Disclaimer: If you are participating in the payment plan and you are purchasing the student health insurance, your insurance premium will not be paid until your tuition and fee account is paid in full. Therefore, upon receipt of your final payment, we will submit payment to the insurance broker and coverage will begin, retroactive to the beginning of the policy period. Your entire account balance must be paid by the final payment plan due date. A bill will be sent to you at least 10 days prior to each due date. If you are signing up late for the payment plan, payments for prior due dates must be paid at the time you sign up. If a due date is approaching, that payment must be paid by the approaching due date. We reserve the right to charge a $10 late fee for each month your account is more than 30 days past due.Payment plan due dates for this term:Due Date 1 MM slash DD slash YYYY Due Date 1a Due Date 2 MM slash DD slash YYYY Due Date 2a Due Date 3 MM slash DD slash YYYY Due Date 3a Due Date 4 MM slash DD slash YYYY Due Date 4a Installment PaymentYou will make four (4) monthly payments of this amountCurrent Monthly PaymentMonthly payment that is currently duePast Due Monthly Payments (1)As of today, you have already missed one (1) monthly payment, which is due immediatelyPast Due Monthly Payments (2)As of today, you have already missed two (2) monthly payments, the total of which is due immediatelyPast Due Monthly Payments (3)As of today, you have already missed three (3) monthly payments, the total of which is due immediatelyPayment Plan FeeThe Business Office charges this one-time fee per semester for the administration of the payment plan.Total payment todayInformation Release AuthorizationIn order to protect your privacy, federal law restricts Greenfield Community College from discussing your tuition and fee billing information or financial aid status by phone or in person with a parent or other third party without your consent. If you wish to authorize access to that information, you must complete the Information Release Form in MyGCC. You can find this form under My account → Billing → Information Release Form.Student Certification Statement*I understand that by checking the box below I am acknowledging and I agree to the following: My tuition and fee bills will be delivered to me strictly online through my MyGCC account and I will not receive regular bills by mail unless I request it in writing. I am responsible for retrieving all bills once I am notified by email that a bill is available to view and print from my account. Failure to review my e-bill does not constitute a valid reason for not paying my bill on time. I am responsible for payment of any charges shown on my account including tuition, all fees, books, program fees, or any other charges associated with my enrollment in classes, regardless of the source of payment I’ve listed on this worksheet; If a balance remains on my account due to a Federal Title IV return of financial aid funds calculation, I understand that within 45 days from receipt of notification from the Financial Aid Office that my aid has been reduced, I must either pay the balance in full or make repayment arrangements with the Student Billing Office; If a payment has not been made on my behalf by the third party(s) I’ve listed on this worksheet, I understand that charges will be billed to me by or before the end of the semester and I am responsible for paying any outstanding charges within 30 days from the date of the bill; Finally, I understand that any unpaid balance on my account is subject to additional collection action including: denial of additional services from GCC, late fees, collection agency referral, collection fees, and MA State Intercept of state payments due me, including state tax refunds as explained on the reverse of my billing statements. I acknowledge and agree to the above statement today MM slash DD slash YYYY