Visiting Students or Visiting Scholars
Fee Authorization Form
* Fees are assessed on a semester by semester basis.
* This form MUST be completed each semester.
This is to be used to request the application of specific student body fees and authorize payment
from departmental resources. Use this form when providing access to Visiting Students or Scholars.
Name: A number:
Contact Person:
Department:
Email:
Phone:
College:
FEE AUTHORIZATION select only one
Select semester: Summer Fall
Select the fees to be assessed and paid:
$23.00 Option A (2VSB)
Spring
$15.00 Card Fee (2CAR)
$73.00 Option B (2VSA)
* IT Services
* IT Services
Library
Library
** Campus Recreation
*
IT Services includes password management, VPN, wireless and access management.
** Access to the HPER health and fitness facilities include the employee fitness center, Fieldhouse track, basketball courts in
the HPER and Fieldhouse, Racquet Ball Courts can be reserved at the HPER Service Desk. Swimming pools cost on a use
basis.
AR PAYMENT CODE (if known):
or INDEX: ACCOUNT CODE: 761500
I acknowledge that I am the responsible official for this funding and authorize the requested transaction.
I understand this authorization is for only one semester.
I understand I must complete this form each semester I authorize payment.
I understand all recipient questions will be directed to the sponsoring department.
I understand all correspondence with the recipient will be facilitated by the sponsoring department.
I understand processing will take 2-3 business days.
CHECK THIS BOX UPON YOUR UNDERSTANDING
AND APPROVAL OF THIS PROCESS.
Printed name
Date
Page 1 of 1
Revised 2/2/15 by Taya Flores
(7-1766)
AUTHORIZATION
PURPOSE OF FEE AUTHORIZATION FORM
Student will pay. This can be done online or at the Registrar's Office once fee has been applied.
