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)*
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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
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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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