Fee Waiver Request Form

Student Name: Student ID#: ____0 ______ _______ Student E-mail (required): ___ _______ Advisor Name: Term/Class: Department: Fee to be removed (Please Circle): (DROP) /Withdraw Fee Amount: ______________________ Registration Fee Other (Please Specify) ______________ Comments (please be specific):

________________________________________________ _____________________

Student Signature Date

________________________________________________ _____________________ Advisor Signature Date

________________________________________________ _____________________ Advising Supervisor Signature Date

Received by Cashier: ______________________________________________ Date: ____________ Cashier Supervisor: _______________________________________________ Date: ____________ Financial Affairs: _________________________________________________ Date: ____________

APPROVED DENIED

Office Use Only