Fillable Stipend-notetaker-invoice CSUCI > DRP Stippened Note-taker Invoice

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Stipend-notetaker-invoice CSUCI > DRP Stippened Note-taker Invoice

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STIPEND NOTE TAKER INVOICE
Date:
To: Cal State University Channel Islands
Accounts Payable
One University Drive
Camarillo, CA 93012
From (payee):
Name:
First MI Last
Mailing Address:
City: State: Zip:
Phone:
E-Mail: @myci.csuci.edu
Re: Classroom notes provided to student(s) with disabilities.
Notes Provided For:
Semester:
Course 1 Today’s Date: Class: Section:
Days of the week class meets:
Mon
Tus Wed Thur Fri Sat
Course 2 Today’s Date: Class: Section:
Days of the week class meets:
Mon
Tus Wed Thur Fri Sat
Course 3 Today’s Date: Class: Section:
Days of the week class meets:
Mon
Tus Wed Thur
Fri
Sat
Course 4 Today’s Date: Class: Section:
Days of the week class meets:
Mon
Tus Wed Thur Fri Sat
Total Number of Courses: @ $100 per course
Total Number of Activities/ Labs: @ $50 per course
Total Due:
P
ayee Signature:
This form must be TYPED
with a wet
signature.
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Stipend-notetaker-invoice CSUCI DRP Stippened Note-taker Invoice

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Completed 11 February 2020

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