Please send completed form to the Office of the Registrar, SSC 240
Course Information
Program
Subject (e.g. BIOS)
Course Number (e.g. 5300)
Course Title
Course ID (e.g. 090361)*
Change
Effective Date or Semester
Prior Course Fee
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Fee Information
Estimated Enrollment
Fee Amount
Fall
Enrollment
Spring
Enrollment
Summer
Enrollment
Total
Enrollment
Fee Amount
Requested
Estimated
Total Revenue
Form Completed By
Date
Phone Number
Signature Approvals
Dean Date
Executive VP for Academic Affairs Date
*Please contact (817) 735-2201 for assistance in completing this form.
For Office Use Only
Entered by __________ Date Entered _____________
Course Fee Request Form
University of North Texas Health Science Center
Office of the Registrar, SSC 240
3500 Camp Bowie Blvd.
Fort Worth, TX 76107-2699
(817)
735-2201 / Fax (817) 735-0448
registrar@unthsc.edu
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