Please send completed form to the Office of Student Finance, SSC 150
Course Information
Program
Subject (e.g. BIOS)
Course Number (e.g. 5300)
Course Title
Course ID (e.g. 090361)*
Change
Effective Date or Term Course Fee Amount
Add New Fee Remove Fee
Reduce Fee Increase Fee
Fee Information
Description of services provided by this Fee: List Applicable TEC
Costs to be Incurred:
Estimate dollars to be spent in each category (e.g. handouts -$435, wages $3,200, benefits $501).
Estimated Enrollment
Fall
Enrollment
Spring
Enrollment
Summer
Enrollment
Total
Enrollment
Fee Amount
Requested
Estimated
Total Revenue
Approvals
Dean/School
Date
Provost
Date
For Office Use Only
Entered by __________ Date Entered _____________
Course Fee Request Form
University of North Texas Health Science Center
Office of Student Finance, SSC 150
3500 Camp Bowie Blvd.
Fort Worth, TX 76107-2699
(817) 735-2026/ Fax (817) 735-0677
StudentFin@unthsc.edu
Effective 09/01/2019
Budget Office
Student Finance
*Please contact (817) 735-2026 for assistance in completing this form.
Date
Date
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signature
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