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Request for Course Fee Form – NEW request
Course Name ____________________________
Course # ________ Purpose of fee: Lab ___ Lecture _____
# of credits ______ Department Name _______________________
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 - ________
Course Fee Description:
Justification of the fee. This needs to be specific; types of supplies, field trip details, etc. Please include calculations.
Average miles driven (if applicable)
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.