Special Payment Request - Arkansas Christian Academy

Please complete the form below in order to be considered for special payment arrangements. Please be advised that all forms must be submitted in advance to allow our staff adequate time to review your case. We are not responsible for any late fees that should occur due to forms submitted with inadequate notice. Please continue to make any payments as scheduled while awaiting a decision. Be advised there is a $50 processing fee added for any approved payment schedule changes.

1. First Name of Requesting Parent *

2. Last Name of Requesting Parent *

3. Please list all students for whom you are requesting a special payment schedule *

4. Requested change *

One time exception to extend my due date for the entire fee amount Allow me to split my bill and schedule equal payments Allow me to pay by check

5. Please explain the reason for your request *

I understand that submission of this request does not guarantee acceptance, and by submitting this request, my case will be reviewed and a decision will be provided to me.

6. *

I understand

7. Enter Your Email Address: *