CULTURE, DESIGN AND FINE ARTS IN NEW YORK SUMMER PROGRAM

July 1331, 2015

School of Visual Arts

Office of Programs for International Students
opis@sva.edu

Payment Form

Please complete and return this form with your payment to the Office of Programs for International Students.
Please note: Deposit of $400 must be received by May 1, 2015 to reserve your space.
If we are not able to accept you into the program, your deposit will be refunded in full.
Please Print
Last Name/Surname

First Name/Given Name

Middle Name

SVA ID Number (if applicable)

Housing: I intend to stay in SVA housing. Yes No

Cost: Tuition = $2400 (includes weekend and evening activities program fees)
Housing (optional) = $1500 (shared room accommodation; includes breakfast MonFri)

Payment Type (please check one)

Credit Card
Visa MasterCard American Express Discover Card JCB International Card
Credit Card Number

Expiration Date

Cardholders Name

Cardholders Signature

Check
*All checks must be paid in U.S. dollars and be drawn from a bank with a U.S. address.
Checks should be made payable to: School of Visual Arts.
Check Number

Amount US $

Wire Transfer
*If you wish to pay via wire transfer, please contact opis@sva.edu to obtain the account information.

Payment information listed above is for (check one)

Tuition deposit fee only: $400
($2000 tuition balance and $1500 fee for housing, if desired, must be paid no later than June 5, 2015)
Full tuition only (deposit included in full tuition payment; no housing desired): $2400
Full tuition and housing fee: $3900
Other amount (please fill in) 
For (please fill in)