| Statement of Certification |
By selecting that you agree, you are certifying that you are the person who has completed the information furnished on all sections of this application. You are certifying that to the best of your knowledge, the information furnished is true and complete. You understand that if found to be otherwise, it is sufficient cause for delay of admission, loss of credit, rejection or dismissal. You also understand that by enrolling in courses at Adams State University you are subject to all academic policies as they relate to your enrollment including but not limited to the Academic Integrity Policy 100-03-01. For more information regarding Academic Integrity, please go to http://www.adams.edu/extended_studies/undergrad/academic-integrity.php *I understand that by submitting this information via electronic transmission that I acknowledge the above in lieu of a signature*
By completing registration for this semester I am entering into a legal binding contract with Adams State University
(ASU) to pay all tuition, fees and related expenses, including late fees. I accept full financial responsibility for
each registered course. I authorize ASU, the Extended Studies department, and their respective agents and contractors
to contact me regarding my loan, student account or any balance owed to ASU at the current or any future number either
provided or acquired for my cellular phone or other wireless device using automated telephone dialing equipment or
artificial or pre-recorded voice or text messages or e-mail address either provided or acquired and/or the ASU student
e-mail address I am provided by the institution. Past due balances are subject to placement with a collection agency.
I agree to reimburse ASU the fees of any collection agency, which may be based on a percentage of debt up to 40%,
and all costs and expenses, including reasonable attorney's fees ASU may incur in such collection efforts in accordance
with Colorado statutes. ASU may also certify to the Colorado Department of Revenue my name, social security number, amount
of debt, and other identifying information required by the Department for collection of my debt from the tax rebate amounts
owed to me, if any. C.R.S Â§23-5-115
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