Fillable SWCC CERTIFICATION OF DEPARTMENT/GRANT PROGRAM/LOCAL FUNDS AUTHORIZATION OF (Southwest Virginia Community College)

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SWCC CERTIFICATION OF DEPARTMENT/GRANT PROGRAM/LOCAL FUNDS AUTHORIZATION OF (Southwest Virginia Community College)

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SWCC CERTIFICATION OF DEPARTMENT/GRANT PROGRAM/LOCAL FUNDS
AUTHORIZATION OF PAYMENT OF STUDENT TUITION/FEES
Revised 04/07/14
Original form shall be completed and signed by authorized agency official and shall be
submitted to the Business Office. All information except signatures shall be typed.
Date:_________________________
THIS IS TO CERTIFY THAT SWCC: _______________________________________________
Department/Grant Program/Local Funds
HAS AGREED TO PAY TUITION/FEES EXPENSES, FOR STUDENTS AS LISTED BELOW,
DURING_________________SEMESTER, 20_____.
Department Code_______________ Grant Line Item_______________
______________________________ ____________________________
Signature Requestor Date Signature Vice President Date
______________________________ ____________________________
Signature Supervisor Date Signature President Date
BUSINESS OFFICE USE ONLY:
Initial Review by:____________Date:_______ Keyed by:_______________ Date________
Final Review by:_______________ Date:_______
Student Empl ID
Last Name, First Name
Authorized
Tuition/Fee Amount
GRAND TOTAL
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SWCC CERTIFICATION OF DEPARTMENTGRANT PROGRAMLOCAL FUNDS AUTHORIZATION OF (Southwest Virginia Community College)

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Completed 27 July 2020

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