UNIVERSITY TUITION/TECHNOLOGY FEE AWARD FORM

STUDENT INFORMATION SECTION: FOR SEMESTER (CIRCLE ONE) : FALL SPRING SUMMER
YEAR ___________
If you are receiving a University award to pay any portion of your tuition charges, please complete the student section of this
form and forward to the appropriate department sponsoring your award.

NAME: LAST:__________________________________ FIRST: _______________________M.I. ____ LIN#_______-______-______

DATE:______________
ENROLLED IN THE COLLEGE OF (CIRCLE ONE) : a) Arts & Science b) Business & Economics c) Education d)
Engineering

NAME OF DEPARTMENT YOU WILL BE ASSOCIATED WITH : _______________________________________________________________________________________

DEGREE (CIRCLE ONE) : a) MASTERS b) DOCTORATE CERTIFICATION STATUS (CIRCLE ONE) : a) FULL-TIME b) CERTIFIED
FULL TIME c) PART-TIME

POSITION (CIRCLE ONE) : a) TEACHING ASSISTANT b) RESEARCH ASSISTANT c) GRADUATE ASSISTANT d)

FELLOWSHIP

# of credits you expect to register for: ______ ___ # of credits you anticipate paid by your University Tuition Award: ___________

Student Signature: ______________________________________________________ Date: ______________________________

DEPARTMENTAL APPROVAL SECTION: TUITION AWARD |BURSAR’S OFFICE USE ONLY

CREDIT |
HOURS INDEX - ACCOUNT # AUTHORIZED SIGNATURE APPROVAL DATE | DETAIL CODE EXEMPT CODE
AMOUNT INITIALS DATE |
- 7 |____ ____ ____________
__ _____ _______
- 7 |____ ____ ____________
__ _____ _______
Acct #’s: 75810 –Tuition (Non-Research) 73571 – Tuition (Research)
DEPARTMENTAL APPROVAL SECTION: TECHNOLOGY FEE AWARD |BURSAR’S OFFICE USE
ONLY
AMOUNT INDEX - ACCOUNT # AUTHORIZED SIGNATURE APPROVAL DATE | DETAIL CODE EXEMPT
CODE INITIALS DATE |
(300000-699999 only)- 73572 |____ ____
__ _____ _______
(DEAN’S SUBSIDY)- 73572 | ____ ___
__ _____ _______
NOTE: Dean’s Subsidy is for a maximum of $75 and is only applicable for college approved TA positions.
OFFICE OF RESEARCH APPROVAL SECTION: 100% Research 50% Research, 50% Cost Share

____________________________ $ /credit _______

Signature Tuition Rate per Credit Hour Date

Return Completed Form to the Bursar’s Office as soon as possible but no later than September 28, 2007 for Fall
2007 and January 31, 2008 for Spring 2008