Please send completed form to the Office of the Registrar, SSC 240
Course Number (e.g. 5300)
Effective Date or Semester
□ Add New Fee □ Remove Fee
□ Reduce Fee □ Increase Fee
Description of services Provided by this Fee:
Estimate dollars to be spent in each category (e.g. handouts -$435, wages $3,200, benefits $501).
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 _____________
University of North Texas Health Science Center
Office of the Registrar, SSC 240
3500 Camp Bowie Blvd.
Fort Worth, TX 76107-2699
735-2201 / Fax (817) 735-0448
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