College Channel Enrollment Financial Aid & Plus Mother's InformationMother's NameMother's Cell PhoneMother's Email Father's InformationFather's NameFather's Cell PhoneFather's Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhonePrimary Email As of today, what is the parents' marital status Married / Remarried Divorced / Separated Widowed Never Married Not Married Living Together Other Other Student 1Student No. 1 (Name)Date of Birth MM slash DD slash YYYY Student No 1. Cell PhoneStudent No. 1 Email Name of Student No. 1 Current SchoolYear of High School GraduationStudent 2Student No. 2 (Name)Date of Birth MM slash DD slash YYYY Student No 2. Cell PhoneStudent No. 2 Email Name of Student No. 2 Current SchoolYear of High School GraduationYour Selected ServiceSelect Your service. Financial Aid Plus - $1995 Financial Aid Plus - E-Z Pay Option: 3 monthly payments of $685 Financial Aid Plan - $995 Financial Aid Plan - E-Z Pay Option: 2 monthly payments of $520 Additional Student $250.00 Colleges require that renewal financial aid forms be completed each year to re-qualify for aid. Annual renewal fee to assist in completing all required aid forms only $450.00Payment OptionsPlease make checks payable to: Lerner and Esposito College Consultants Inc 23 Abbey DriveCommack, NY 11725Please charge my credit card American Express Visa MasterCard Discover Zelle (jan@thecollegechannel.net) Name On CardCredit Card No.Zip CodeExpiration DateSecurity CodeConsent I am an authorized user of the above credit card and agree to charge the above charges.Date MM slash DD slash YYYY Δ
