Retroactive or Late Fee Remission Adjustment Request
Use this form for fee remission adjustments after November 30 for Fall appointments or April 30 for Spring appointments, and for prior semester appointments.
Email address *
HIRING UNIT INFORMATION
Department or Hiring Unit *
Your answer
Contact Name *
Your answer
Alternate Contact Email (optional)
Your answer
Contact Phone *
Your answer
STUDENT INFORMATION
Student's Name *
Your answer
Student ID (SID) *
Your answer
Employee ID (EID) *
Your answer
APPOINTMENT INFORMATION
Semester and Year *
If Other: Semester and Year
Your answer
Title Code *
Your answer
Percentage Time *
Your answer
Begin Date *
MM
/
DD
/
YYYY
End Date *
MM
/
DD
/
YYYY
What type of adjustment is needed? *
Other Fee Remission adjustment requested
Your answer
CHART STRING INFORMATION
Please provide entire chart string(s) to which fee remission should be debited or credited.
Chart String *
Your answer
Chart String
Your answer
Chart String
Your answer
A copy of your responses will be emailed to the address you provided.
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