| This form may be completed online but
must be printed for signatures.
Submit original and one (1) copy. |
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| CONTRACT AND GRANT TUITION AND FEES |
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| Contract/Grant
Number |
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For which
Term? Hours |
Interim Term |
| Assigned by
Awarding Agency |
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__ Interim Term |
20 |
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First Term Summer |
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__ First Term Summer |
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Second Term Summer |
| Project
Director (Name) |
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__ Second Term Summer |
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Both Term Summer |
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__ Both Term Summer |
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Fall Semester |
| University
Account Number |
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__ Fall Semester |
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Spring Semister |
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__ Spring Semester |
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| Funding
agency's policy prohibits payment of out of state tuition (check only ONE): |
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Yes |
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No |
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| Type in the
information below in the unshaded areas only. |
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| Social Security Number |
Name
(Last, First, M.I.) |
Charges |
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APPROVED: |
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| Project
Director/Project Investigator |
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Contract & Grant Accounting |
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Date |
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| Note: If grant allows for both in and out of
state tuition, please mark it on this form and do not fill out the
"Special Request |
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| for
Out-of-State Tuition Award for Graduate Assistants". |
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