REQUEST FORM

MONTHLY PAYMENT REQUEST

SUBMIT ONLY IF INTERESTED IN A MONTHLY PAYMENT PLAN OR IF DIRECTED TO SUBMIT BY NEWU FINANCE

Student Name(Required)

First Last

Student Personal Email(Required)

Use the same email with which you applied to NewU if still active

Student Mobile Phone(Required)

Student Date of Birth(Required)

Student Social Security Number(Required)

Who will be primarily responsible for paying your bill?(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Mobile(Required)

Parent/Guardian Email(Required)

Parent/Guardian Social Security Number(Required)

Person Who Will Make Payment(Required)

First Last

Relationship to You(Required)

Financially Responsible Person Mobile Phone(Required)

Financially Responsible Person Email(Required)

Financially Responsible Person Social Security Number(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the address where you want to receive paper mail

Home Address (Where You Live)(Required)

Same as Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the address where you currently live

This field is hidden when viewing the form

Financial Aid Applicant(Required)

TRUE

NewU University may process my request for a monthly payment plan, store data I submit, or request additional information. I understand that approval is not guaranteed and is always at NewU University's sole and absolute discretion. Questions? Contact us at [email protected] or 202-968-1001.

REQUEST FORM

MONTHLY PAYMENT REQUEST

SUBMIT ONLY IF INTERESTED IN A MONTHLY PAYMENT PLAN OR IF DIRECTED TO SUBMIT BY NEWU FINANCE

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