Please complete this form for each student, each semester that your organization plans to sponsor them for classes at Spoon River College.

Third Party Payer
This is in reference to:
$
regardless of whether the aforementioned student ends their relationship with our organization or does not fully complete the course.

All costs incurred as a result of this authorization for payment will be paid to Spoon River College within 30 days of receipt of bill for charges.

These funds may be used for: (check all that apply.)
Please indicate whether any unused funds for a given semester should be:

Please note that funds cannot be held for more than two academic years.  All funds on account at that time will be refunded to your refund choice selected above.  (If funds are not refundable to the student, any remainder will be returned to your organization.)

Please direct billing or inquiries to:

Joseph Shelko
Spoon River College
208 S. Johnson St.
Macomb, IL  61455
Email Joseph
Phone:  309-833-6073

Please send payments to:

Attention: Emilie Palmer
Financial Aid/Business Office
Spoon River College
23235 N County Highway 22
Canton IL 61520