Information Technology Apply on Distance Learning

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					Idaho State University                                                                  Due Dates:
                                                                                        December 1 for subsequent Fall Semester
Class Fee Authorization Form                                                            July 1 for subsequent Spring Semester
                                                                                        August 1 for subsequent Summer Semester

                                                                                                                                (Semester)        (Year)

Detail Code:                                                                       Fee Effective (Semester)
Department:                                                                        Telephone Contact:                        Stop #
Contact Person:                                                                    Email Address:
Complete all that apply for Fee to be Assessed:
                                  One Time                                         Continuous                                Cancel Fee
                                  Distance Learning                                Campus other than Pocatello

                                                                                                               Anticipated       Prior         Requested
  Index #*           Dept.           Course                                   Class Name                       Enrollment        Amt              Amt

                 * Not required if requesting the fee for all sections of this course
Explanation: (attach additional sheets if necessary)

In order to expedite your request, all information requested should be included

Approval Signatures:

Department Chair                                  Date                                         College Dean                                  Date

                                                                                                              Approved                       Denied
Provost/Vice President for Academic Affairs                               Date

Distribution: (original will be retained in the Office of Academic Affairs)
      Finance & Administration                    Information Technology Services (EDS)                       College             Department
                                                  (for distance learning/online)

                                                                                                                                Revised October 2009

Description: Information Technology Apply on Distance Learning document sample