Removal of Financial Holds

ATTN: Student Accounts Office, Bouillon 110

400 E University Way, Ellensburg, WA 98926-7492

Full Name *

Student ID # *

I am hereby requesting the financial holds be temporarily removed from my account for the following service: *

I would like to enroll for classes during the following quarter (select below)

I would like to receive transcripts to submit to my third party payer (as of today's date)

I am sponsored by a Guaranteed Source (example: SACM or GoArmyEd)

I would like to enroll for classes during the following quarter: *

Terms & Conditions:

Please review the following terms and conditions. Once understood, type your initials after the statement to indicate you understand the terms and conditions before you and approve to move forward with the removal of the financial hold.

I am aware that I must make a payment on my account today. *

I am aware that it is my responsibility to monitor my account for activity. *

I am aware that it is my responsibility to pay or appeal late fees accrued on my account due to late payments. *

I am aware that failure to make payments for the agreed amount on the agreed upon day will result in termination of the agreement. Holds will be placed back on the account and future arrangements to lift holds will not be made. *

I am aware, that if approved, this form will give me until midnight on the day my petition is approved to get enrolled/transcripts unless otherwise arranged with student accounts. *

Note (if applicable):

It is very important to monitor your account for activity. There will be a balance on your account at any time if your third party payer declines payment. This means that your balance could be zero at the start of the quarter, but can increase if the third party payer declines payment later on in the quarter.

We cannot guarantee that we will be able to lift your hold; your plan for payment must be reviewed and approved first.

Total amount I owe: * $

First payment amount: * $

Paid on today's date: *

Month

Day

Year

Second payment amount (if applicable): $

will be paid on:

Month

Day

Year

Third payment amount (if applicable): $

will be paid on:

Month

Day

Year

Fourth payment amount (if applicable): $

will be paid on:

Month

Day

Year

Fifth payment amount (if applicable): $

will be paid on:

Month

Day

Year

My account will be at $0 by *

Month

Day

Year

Additional Notes

By entering your name below, you certify that you understand the process and the information contained on this form. Your typed name counts as your electronic signature. *

Please re-enter your Student ID # *

Date electronically signed *

Month

Day

Year

If you have not received a response within 10 business days, visit or contact the Student Accounts Office by email at studentaccounts@cwu.edu or by phone at 509-963-3546.

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ATTN: Student Accounts Office, Bouillon 110

400 E University Way, Ellensburg, WA 98926-7492

Terms & Conditions:

Note (if applicable):

If you have not received a response within 10 business days, visit or contact the Student Accounts Office by email at studentaccounts@cwu.edu or by phone at 509-963-3546.

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