Request for a Statement of Account

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					                       Student Accounts Official Itemized Statement

            Name:                                                          Date: July 13, 2011
           Address:                                                         ID:

                       Course Number and Name                            Hours             Charges                Grades

                                                TOTALS                       0               $0.00

                                                                         PREVIOUS BALANCE

                                                                                             Subtotal             $0.00
                                                                                      Technology Fee
                                                                                        Intensive Fee
                                                                             Administrative Fee
                                                                  Payment Plan Participation Fee
                                                                        TUITION AND FEES                          $0.00

                                                                                 Tech Fee Waiver
                                                                                Federal Pell Grant
                                                                        Tuition Discount - Military
                                                                                  Student Payment
                                                                                  REDUCTIONS                      $0.00

                                                                       REMAINING BALANCE                          $0.00

NOTE: This form was prepared according to the most current information in our office for your use. This form only verifies receipt of payment
                           for the courses indicated. It does not guarantee the actual completion of the course.

    Authorized Personnel:                                                                            Date:           July 13, 2011

                        This receipt is unofficial unless it has the signature of a Authorize Personnel

Description: Request for a Statement of Account document sample