Fillable Student Account Adjustment Request (Arkansas Tech University)

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Student Account Adjustment Request (Arkansas Tech University)

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Arkansas Tech University
Student Account Adjustment Request
Select the appropriate detail code beside the corresponding charge group. Please list a thorough description of the adjustment/charge requested
including the original transaction if adjusting. Include the reason for the adjustment and include backup/documentation of the original transaction.
Fine Fee Charge Adjustment
Housing
Baswell
Brown
Caraway Eastgate
Hughes
Jones
Nutt
Overflow
Paine
Phase II 2
Phase II 4
Roush
South
St Suites
Turner
Vista Place
WilsonComm 2
Comm 4
Critz
Tucker
Other Charges or Reductions
Library
Meal Plan
Post Office
Pub Safety
Registrar Infirmary
Other
Detailed description of reason for adjustment (Attach documentation of original transaction):
Charge Requested by _______________________________________
Department Head Approval__________________________________
Director of Payroll and Special Services_________________________
Date______________
Date______________
Date______________
Amount
Name T Number
Date
Term
* Please provide detail code for Tuition Reduction and Other below
M Street
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Student Account Adjustment Request (Arkansas Tech University)

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Completed 23 July 2020

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