Fillable CARE Text Book Request Form 2017 CARE Account # _____

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CARE Text Book Request Form 2017 CARE Account # _____

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The CARE Text Book Request Form 2017 CARE Account # _____ form is 1 page long and contains:

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  • 2 check-boxes
  • 42 other fields

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SJC: Account _____
MVC: Account _____
Mt. San Jacinto College District
Text Book Request/Reimbursement
__________________________________________________ _______________ SJC MVC
Last Name First MI SID #
__________________________________________________ _____________________________
Address Phone Number#
Course/ Section#
Book Title
Attach Book Quote/Receipt
This voucher authorizes the above named student to purchase required
and recommended textbooks, study guides and related supplies not to exceed
Student: The books and/or supplies purchased are required or recommended by my instructor. I also
understand that the misuse of CARE funds may result in my termination from the CARE program and I may
be required to repay funds.
___________________________________________
Student Signature Date
___________________________________________
Leslie Salas, EOPS/CARE Director Date
Attention Book Store: Attach receipts to all copies; White- Bookstore, Yellow-CARE, Pink- student, Goldenrod-Originator
Sub Total
Discount
Tax
$ 0.00
$ 0.00
$ 0.00
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Completed 29 December 2020

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