Updated 6/2016
Category IV and V Fee Proposal Form
California State University Channel Islands
Fee Proposal for Presidential Review
Name of Proposed Fee:
Check Fee Category: (see Executive Order 1102)
☐ Category IV: Non-coursework materials, services, penalty, use of service fees
☐ Category V: Self Support Fees (Parking, Housing, Extended Education)
Submission Dates/Deadlines
September 1
st
– for fees to be effective by spring
st
– for fees to be effective by fall and summer
Proposals submitted after the submission deadline will be considered during the next FY.
(Note: For Category III (Course fees) requests please see the “Student Course Fee Request Business Process” and use the
request template and travel budget form if applicable.)
Proposed action effective (specify date): ______
Additional Comments:____________________________________________________________________
☐ Establish a new fee/person of $
☐ Change an existing fee. Current amount of the fee/person: $
CFS Fund: CFS Dept ID:
☐ – Increase the fee/person to $
☐ – Decrease the fee/person to $
☐ – Eliminate the fee
☐ Update fee language, usage, materials, or services only (no change in fee amounts)
Requester: Department:
Contact #: Email Address:
Also please complete and submit the following completed forms:
• Attachment 2 - Rationale for the Fee
• Attachment 3 - Fee Revenue/Expense Projections (and updated Proforma if applicable)
Requestor Signature: Printed Name Date
Reviewed/Approved: I recommend approval of the proposed fee action.
AVP Signature:
Printed Name
Date
Provost/Vice President Signature:
Printed Name Date
Please submit the original signed cover page and attached pages to:
Budget & Planning Office, Lindero Hall
click to sign
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