Graduate Assistant Form

Please complete the information below to have the Graduate Assistant Waiver applied to your account.

Important Information

If you want to setup payroll deduction for your remaining account balance, you must complete the payroll deduction section below. The following end dates apply:

Fall term deductions must end by November 30th

Spring term deductions must end by April 30th

Summer term deductions must end by July 30th

Waivers can take up to one week to post. Upon completion of your order, you will receive an email with the information you entered. This is confirmation the Treasurer's Office has received your request. Please allow one week to process. Do not complete a second form.

The Treasurer's Office will review information entered and you will receive an email to your ASU student email if adjustments are needed. By entering your information, you are agreeing to the Attestation shown below and verifying all information is correct.

Attestation
A. Each payment must be paid in full when due. If a payment is missed, the university is under no obligation to renegotiate this agreement. I authorized Arkansas State University to deduct or apply my paycheck toward my account.
B. Any unpaid charges will remain the liability of the debtor and will be remitted to a collection agency if not paid in full according to the terms of this agreement. The debtor agrees to bear all collection costs and attorney’s fees associated with the debt. If enrollment is voided, the remaining unpaid fees will be adjusted in accordance with applicable university policies.
C. Previously paid installments will not be refunded as a result of the student’s withdrawal from the university unless it is determined that extenuating circumstances warrant such action.
D. Any financial aid, scholarships, or stipends received after the signing of this agreement shall be applied against the student’s outstanding charges. The university also reserves the right to apply any wages or other sums owned to the student against this debt at any time, without regard to the repayment dates. Any money received pertaining to this account will be applied against the amount due, i.e. payroll, financial
aid, attachment of state income tax (ACT 372 of 1983 as amended).
E. Arkansas State University reserves the right to accelerate the terms of this agreement and demand payment of the entire obligation in the event of insolvency, if bankruptcy proceedings are instituted against the signee/student or if the student violated Arkansas State University’s rules of conduct.
F. I agree to pay any charges incurred after signing this agreement in accordance with the provisions of this agreement.
G. By signing, I hereby request the portion of any federal financial aid award that exceeds the charges for the current term be applied toward the prior balance with Arkansas State University.
I hereby acknowledge responsibility for the amount listed above by signing below. The basis for these charges has been fully explains to me and I understand that I will be held liable for this debt according to the terms of this agreement. I agree to pay these charges in full by the terms specified in this agreement.

Note: The price will show zero upon completion of your order as it is only used to collect necessary information.