I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand than any such false statement may subject me to immediate dismissal from the institution.

All personal data and special categories of sensitive personal data collected or processed by the USG must comply with the USG Cybersecurity Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity: www.usg.edu/policies. Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to helpdesk@usg.edu. Otherwise, questions concerning general data privacy can be forwarded to dataprivacy@usg.edu. Signature (below) and submission of this application provides consent to and acknowledgement of the USG Privacy Policy.

Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.

I understand that attending Middle Georgia State University as an international student on an F-1 VISA, I am required the following:

• Minimum 12 credit hours, of which 9 hours must be on campus courses. 
• Tuition must be paid in full, prior to the payment deadline

I understand that attending Middle Georgia State University as a graduate international student on an F-1 VISA, I am required the following:

• Minimum 9 credit hours, of which 6 credit hours must be on campus courses.
• The 9 credit hours can be split between 1st session and 2nd session of the same semester.
• Tuition must be paid in full, prior to the payment deadline

STUDENT FINANCIAL RESPONSIBILITY AGREEMENT

READ CAREFULLY - THIS IS A LEGALLY BINDING AGREEMENT

(Revised 07-01-2021)

This Agreement is entered into between the Student and the Board of Regents of the University System of Georgia, by and on behalf of Middle Georgia State University (MGA). In exchange for registering for classes and receiving education services from MGA, I understand and agree that my eligibility to enroll in classes is expressly conditioned upon acceptance of all terms and conditions set forth in this Agreement.  I understand and agree to the following:

1.        When I register for any class at MGA or receive any service from MGA, I accept full responsibility to pay all tuition, fees and other associated costs assessed as a result of my registration and/or receipt of services on or before the due date.

2.        If I drop or withdraw from some or all of the classes for which I register, I will be responsible for paying all or a portion of tuition and fees in accordance with the published refund schedule.

3.        I am personally responsible for payment of all money due regardless of my eligibility for financial aid or other assistance.

4.        Financial aid or other financial assistance I may receive will be used to pay any and all money due to MGA, including tuition, fees, campus housing and meal plans, student health insurance, parking permits, service fees, fines, bookstore charges, or any other amount, in accordance with the terms of the aid or assistance. If some or all of my financial aid or other assistance is revoked, I will repay all revoked aid that was disbursed to my account.

5.        If I fail to pay all money due by the due date, MGA will place a financial hold on my student account, cancelling my class registration and preventing me from registering for future classes, obtaining transcripts or receiving my diploma.

6.        If I fail to pay all money due by the due date and fail to make payment arrangements acceptable to MGA, MGA may refer my account to a collection agency, and I will be responsible for paying the collection agency fee, which may be based on a percentage of up to 15% of the debt, together with all costs and expenses including reasonable attorney’s fees, necessary for the collection of my account.

7.        I authorize MGA and its agents to contact me at my current and any future cellular phone number(s), email address(es) or wireless device(s) regarding my delinquent student account(s)/loan(s) or any other debt I owe to MGA, or to provide general information from MGA. I authorize MGA and it agents to use automated telephone dialing equipment, artificial or pre-recorded voice or text messages, and personal calls and email messages, in their efforts to reach me.

8.        I am responsible for keeping MGA records up to date with my current physical address(es), email address(es), and phone numbers by logging in to my online student account and making the necessary updates. My responsibility to do so will continue upon leaving MGA for any reason for purposes of continued communication regarding any amounts that remain due and owing to MGA.

9.         I am subject to and responsible for complying with all applicable MGA and Board of Regents of the University System of Georgia policies and procedures.

10.     This Agreement shall be governed by the laws of the State of Georgia without regard to choice of law’s provisions, and all actions arising under this Agreement will be filed and litigated exclusively in the appropriate courts within the State of Georgia.

11.     That I will provide my Social Security number (SSN) or taxpayer identification number (TIN) to Middle Georgia State University upon request as required by Internal Revenue Service (IRS) regulations for Form 1098-T reporting purposes. If I fail to provide my SSN or TIN to Middle Georgia State University, I agree to pay any and all IRS fines assessed as a result of my missing SSN/TIN. I consent to receive my annual IRS Form 1098-T, Tuition Statement, electronically from Middle Georgia State University. I understand that if I do not consent to receive my Form 1098-T electronically, a paper copy will be provided. I understand that I can withdraw this consent or request a paper copy by contacting the Bursar’s Office at (478) 471-2705.