Request for Approval of Material Fee Form

Header: Material Fee Form

ID:Requested by:Catalog Number:Reason for Fee:Describe the tangible personal property the student will receive for this fee:List One Course Objective met from the Course Outline of Record:Continuing value of materials:If there is a health or safety issue, please state.Non-Palomar Vendor for Materials:Who will distribute materials?:Estimated Budget Amount:Establish BudgetIncrease BudgetSpeed Key:Date Filed:NewRevisedDeleteYesNoYesNo

Account:Fund:Organization:Program:Subclass:Proj/Grant:Comet Copy CodeNameSignatureDateExt.BookstoreCashierOtherExt.DateSignatureName

Request Type:Is the District the only source of the materials?

Department Chair ApprovalFee Paid To:

Dean ApprovalDescribe:Revenue Account:Account:Fund:Organization:Program:Subclass:Proj/Grant:Fiscal Approval:Ext.DateSignatureName

Student Financials Approval:

NameSignatureDateExt.

Completed original: Instruction Office
Electronic Copy: Dean, Department, Instruction Office
Resources: Student Fee Handbook, Education Code &76365; Title 5 &&59400-59408
Version Date: March 2006

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