Credit-Free Instructor Payment Request
To be completed by Continuing Education Credit-Free Instructors. One form per course. You must complete and return both a Credit-Free Course Grade
Roster and this Credit-Free Instructor Payment Request form before payment can be processed.
Mail both forms to Manchester Community College Registrar’s Ofﬁce, MS #13, P.O. Box 1046, Manchester, CT 06045-1046 or email both forms to
I hereby certify that I have completed instructing:
I have completed and enclosed the grade roster for this class and request that the payment process be initiated.
Credit-Free Instructor Name MI Last Name
Credit-Free Instructor Signature Date
Course CRN Number
Total Hours Taught