I certify that I have read the collection statement. By signing this Statement, I understand my responsibilities as a participant, student, or parent/legal guardian (if student is under the age of 18), regarding my account. It is my responsibility to ensure that payments are made to my account to cover the costs of my participation. Failure to pay my account with Vermont Technical College could result in my account being sent to an outside collection agency where I will also be responsible to pay reasonable collection costs, including but not limited to attorney's fees, court costs, and other fees.

I certify that all of the above information is accurate and complete. I understand that withholding information requested in this form or giving false information may make me ineligible for admission or continuation at a Vermont State College institution.