University of Minnesota, Crookston
Business Office
University of Minnesota, Crookston
www.UMCrookston.edu
1-800-UMC-MINN
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Request for Course Fee Form – NEW request

Course Name ____________________________

Course # ________ Purpose of fee: Lab ___ Lecture _____

# of credits ______ Department Name _______________________

Instructor __________________________

Amount of Fee $________ Enrollment Planning Assumption for

2010-2011 Fall - __________

Spring - _______

Course Offered: Actual Student enrollment in previous academic year

Fall _____ 2009-2010 Fall – ________

Spring _____ Spring - ________

Both ______

Course Fee Description:

Justification of the fee. This needs to be specific; types of supplies, field trip details, etc. Please include calculations.

Explanation:

Estimated Expenses

Projected Enrollment

Cost/Student

Proposed Fee

Average miles driven (if applicable)

Details

             
             

           
             
             

Please provide a Budget # (chartstring) from where these expenses were previously paid out of.

What is the total dollar amount of expenditures for the course? $________________

What is the total dollar amount proposed to be paid from course fees? $______________

What is the total dollar amount that the department will be paying? $______________

Please complete this form in its entirety and return signed by both preparer and Department Head.

Preparer Signature: ______________________________________

Department Head Signature: _________________________________

***Forms that are not completed or signed will be returned to the preparer and not be eligible for consideration.

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University of Minnesota, Crookston
Business Office

121 Selvig Hall
2900 University Ave
Crookston, MN 56716
218-281-8331
800-UMC-MINN ext. 8331
umcbo@umn.edu