WY Consortium Agreement
Elementary Education Program (all)
English Ed & History Ed (Northwest only)
VCSU "Home" - Wyoming "Hosts"
Casper College - Casper, WY
Central WY College - Riverton, WY
Eastern Wyoming - Torrington,WY
Laramie County CC - Cheyenne, WY
Northwest College - Powell,WY
Western
WY Ccollege - Rock Springs, WY
A consortium agreement, which can exist between eligible schools only, can apply to all the SFA Programs. Under such a written
agreement, students may take courses at an institution other than the "home" institution where the student expects to receive a
degree or certificate and have those course(s) from the "*host" institution count toward the degree or certificate at the home
school. (*Note, the "host" is defined as the non-degree granting institution delivering the course(s).
Student Name:
Last four digits SS#:
Address:
Phone #:
What term? (circle)
Fall
Spring
Term Starts:
Summer
Year 20____
Ends:
I agree and understand:
1. That I am expected to utilize my VCSU email account at all times (this is mandatory for 24/7 communication).
2.
That I must file a form for each campus 'hosting' a course(s).
3. To notify Valley City State University Student Financial Aid Office of any change in enrollment, or if I withdraw from the
host institution immediately by calling VCSU (701)845-7412.
4. To give the host institution permission to release all information necessary to approve this application.
5. I understand that by requesting this consortium I agree to have a grade transcript sent from the 'host' campus to VCSU at
the end of this semester (future aid will be on 'hold' until transcript(s) are received/evaluated by VCSU).
Date:
Student Signature:
Host Institution:
Mailing Address:
Financial Aid Office Phone:
FA Office Fax:______________________________
Courses you will be taking at the Host Institution:
Course Number Course Title
Credit Hrs
Start Date End Date
The "host" institution Financial Aid Office will review this agreement and, if approved, forward it to the "home"
institution (fax to 701-845-7410). The "host" campus agrees not to provide financial aid to this student during this
term and will verify class attendance at the start of each semester.
$_______________
Total Tuition/Fees (plus on campus room/board) due for above enrollment:
Once processed, above payment will be sent to the Host Campus.
Host Campus:
Financial Aid Officer:
Email address contact:
Phone #:
Date:
Revised 3/31/2015