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 07-01-2024)

1. I am Responsible for Tuition, Fees, and Other Costs. 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 a Class, I May Not Receive A Full Refund. 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. If I decide to completely withdraw from MGA, I will follow MGA’s instructions located at https://www.mga.edu/bursar/refunds.php which are incorporated herein by reference.
3. I Am Personally Responsible For My Financial Obligations In All Circumstances. I am personally responsible for payment of all money due regardless of my eligibility for financial aid or other assistance. I understand that administrative, clerical, or technical billing errors do not absolve me of my financial responsibility to pay the correct amount of tuition, fees, and other associated financial obligations assessed as a result of my registration at MGA. I also understand if a payment to my account is returned by the bank for any reason, I agree to repay the original amount of the payment plus the returned payment fee assessed by the MGA bank. Multiple returned payments or failure to comply with any payment plan may result in cancellation of my classes and/or suspension of my ability to register for future classes. 
4. I Will Use Financial Aid For School Related Expenses. 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 because I drop or withdraw from classes and/or from school, I will repay all revoked aid that was disbursed to my account. 
5. My Failure To Pay Will Have Consequences Such As Preventing Future Enrollment. 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, or receiving my diploma. 1 Headings are included solely for convenience. 
6. My Failure To Pay Could Result in Referral to a Collection Agency. 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 third party for collection, such as a collection agency, and I will be responsible for paying any costs (including, but not limited to collection fees), which may be based on a percentage of up to the maximum permitted by law, but not to exceed 15% of the debt, together with all costs and expenses including reasonable attorney’s fees necessary for the collection of my account. Finally, I understand that my delinquent account may be furnished to one or more of the national credit bureaus. 
7. I Authorize Contact By Cell Phone, Email, and Wireless Device(s). I authorize MGA and its agents and contractors 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 and contractors 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. Furthermore, I understand that I may withdraw this consent to call or text my cellular telephone using automated telephone dialing equipment by submitting a clear revocation request to: https://www.mga.edu/marketing-communications/opt-out.php or to the contactor/agent contacting me on behalf of MGA. 
8. I Understand that Official Communication Is Through Email. I understand and agree that my email account through MGA is its official means of communication with me, and I am responsible for reading those emails. 
9. I Understand that MGA Uses Electronic Billing. I understand MGA uses electronic billing (e-bill) as its official billing method, and I am responsible for viewing and paying my student account e-bill by the scheduled due date. I further understand failure to review my e-bill does not constitute a valid reason for paying my bill after the due date. E-bill information is available at [location]. 
10. I Agree To Provide My SSN and Receive Tax Forms Electronically. I agree to provide my Social Security Number (“SSN”) or taxpayer identification number (“TIN”) to MGA 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 MGA, 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 MGA. I understand if I do not consent to receive my Form 1098-T electronically, a paper copy will be provided. I understand I can withdraw this consent or request a paper copy by contacting the Bursar’s Office at bursar@mga.edu. 
11. I Must Keep All My Contact Information Up To Date. I am responsible for keeping MGA records up to date with my current physical/mailing address(es), email address(es), and phone numbers by [explain or refer to institution’s procedure]. My responsibility to keep my contact information up to date will continue upon leaving MGA for any reason for purposes of continued communication regarding any amounts that remain due and owing toMGA. 
12. I Must Follow Relevant Policies and Procedures. 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. 
13. I Have Privacy Rights and Responsibilities. I understand MGA is bound by the Family Educational Rights and Privacy Act (“FERPA”) which prohibits MGA from releasing any information from my education record without my written permission. Therefore, if I want MGA to share information from my education record with someone else, I must provide written permission by following the procedure outlined at https://www.mga.edu/registrar/ferpa/index.php. I further understand I may revoke my permission at any time as instructed in the same procedure. 
14. If I Have Any Form Of Financial Aid, I Also Agree to the Following: 

a. Estimated Aid Is Not Guaranteed. I understand aid described as “estimated” on my Financial Aid Award does not represent actual or guaranteed payment. I understand it is an estimate of the aid I may receive if I meet all requirements stipulated by that specific aid program. 
b. Financial Aid is Contingent on Continued Enrollment. I understand my Financial Aid Award is contingent upon my continued enrollment and attendance in each class upon which my financial aid eligibility was calculated. If I drop any class before completion, I understand my financial aid eligibility may decrease and some or all of the financial aid awarded to me may be revoked. 
 c. I Will Repay Revoked Aid. If some or all of my financial aid is revoked because I dropped or failed to attend a class, I agree to repay all revoked aid disbursed to my account and resulted in a credit balance refunded to me. 
d. I Agree that Aid May Be Applied To My Account. I agree to allow financial aid I receive to pay any and all charges assessed to my account at MGA such as 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. 
e. Federal Aid: I understand any federal Title IV financial aid I receive, except for Federal Work-Study wages, will first be applied to any outstanding balance on my account for tuition, fees, and room and board. Title IV financial aid includes aid from the Pell Grant, Supplemental Educational Opportunity Grant (SEOG), Direct Loan, PLUS Loan, Perkins Loan, and TEACH Grant programs. I authorize MGA to apply my Title IV financial aid to other charges assessed to my student account such as student health insurance, parking permits, bookstore charges, service fees and fines, and any other education related charges. I further understand this authorization will remain in effect until I rescind it or the end of MGA’s authorization term, and I may withdraw it at any time in my SWORDS account. 
f. Prizes, Awards, Scholarships, Grants: I understand all prizes, awards, scholarships, and grants awarded to me by MGA will be credited to my student account and applied toward any outstanding balance. I further understand my receipt of a prize, award, scholarship, or grant is considered a financial resource according to federal Title IV financial aid regulations and may therefore reduce my eligibility for other federal and/or state financial aid (i.e., loans, grants, Federal Work-Study) which, if already disbursed to my student account, must be reversed and returned to the aid source. 

15. This Is The Entire Agreement Between Me and MGA. This Agreement supersedes all prior understandings, representations, negotiations, and correspondence between the student and MGA, constitutes the entire agreement between the parties with respect to the matters described, and shall not be modified or affected by any course of dealing or course of performance. This agreement may be modified by MGA if the modification is signed by me. Any modification is specifically limited to those policies and/or terms addressed in the modification. 
16. Additional Provisions. This Agreement is governed by the laws of the State of Georgia without regard to choice of law provisions, and all actions arising under this Agreement will be filed and litigated exclusively in the appropriate courts within the State of Georgia. If any provision, term, or clause of this Agreement is declared illegal, unenforceable, or ineffective in a legal forum with competent jurisdiction to do so, this Agreement shall be deemed severable, and all other provisions, terms, and clauses of the Agreement will remain valid and binding on the parties.