Re-registration Accountability Contract

Re-registration Accountability Contract for courses dropped due to non-payment.

This form is only for use by remote students who were enrolled in online courses. If you are on campus or were enrolled in any in-person classes, you must go to the Registrar's Office to submit the form.

Terms and Conditions

By completing and submitting the request form below, students agree to the following Terms and Conditions:

I understand that I have been allowed to re-register for my dropped classes on the condition that payment or payment arrangement will be made with MSU student Accounts Office within 5 business days.
I am responsible for the charges associated with my re-registration. I accept my responsibility to pay the bill, finalize my financial aid, and/or set up a payment plan within the allotted time.
I understand that if I do not fulfill my obligation within 5 business days of completing this request, a hold will be placed on my student records that will prevent future registration. If collection is required on an unpaid balance, I agree to be responsible for additional collection costs up to 33.3% and reasonable attorney costs as required. Collection accounts are reported to credit bureaus.

denotes required fields.

Student Information

Last Name

First Name

Last 4 Digits of Student ID -xxxx1234

Phone Number (xxx) xxx-xxxx

Email Address

How could we have communicated better to keep you enrolled in your courses this semester?

Signature

Date

Signature

I have read the application information, agree to the above terms and conditions, and verify that all above information is correct and current.

I Agree

I Disagree

Re-registration Accountability Contract