UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE

FORM TITLE:  FEES AND DEPOSITS REQUEST
NUMBER:      FORM 0116 PITT 1860
PROCEDURE:   09-05-03


TO BE COMPLETED BY THE ORIGINATOR:

1.   Date of request.

2.   Effective date (MM/DD/YY) or term (YYN) for implementing new or
     revised fee/deposit rate.

3.   Check to indicate whether fee or deposit is course related, major
     related, or other, e.g., application fees, service fees, etc.
     Then indicate:

     New       Fee or deposit to be created
     Change    Increase or Decrease to an existing fee/deposit.

4.   Name, campus address, and campus telephone number of originator
     of request.

5.   Name of Responsibility Center and Department administering the
     fee or deposit.

6.   Description of the proposed use for the fee or deposit, e.g.,
     University fee, academic fee or deposit, service fee,
     professional and informal educational program fee, etc.

7.   Proposed dollar amount of fee or deposit.

8.   Existing four-digit ISIS fee code.

9.   Check one to indicate whether approval of the request will result
     in an increase, decrease in the budget (i.e., after requests
     submitted after budget approval), or no change in the budget.

     If the fee or deposit results in a budget increase or decrease,
     complete and attach a Budget Modification Request form.

10.  Dollar amount of budget change.

11.  Proposed Account Number for depositing fee or deposit income.

For fees and deposits not associated with specific courses or majors,
skip to step 17, Approvals.


 **FOR COURSE AND MAJOR FEES, COMPLETE THE REVERSE SIDE OF THIS FORM**

Course Fee Data

12.  Check only one, to indicate:

     Fee assessed for every course taken - The course should be
     assessed for each course associated with this fee, and a student
     will be charged multiple fees if more than one of these courses
     is taken in the same term.

     Fee assessed only one time per term - The student is to be
     assessed the course fee only once per term, regardless of how
     many courses associated with this fee are taken in the same term.

13.  For all courses associated with this fee or deposit, enter:

     -    Subject
     -    Four-digit course number
     -    Course Title
     -    Course Type Code (See Form for listing of codes.)

Major Fee Data

14.  Check all that apply to indicate the term for which the major fee
     should be charged.

15.  Six-digit Academic Program Code (See SPI 66).

16.  Description of Academic Program Code.

Approvals

17.  Signature of the appropriate Dean, Director, or Campus President.

18.  Signature of the appropriate Senior Officers or Provost, as
     indicated.


TO BE COMPLETED BY THE OFFICE OF BUDGET, PLANNING AND ANALYSIS:

19.  Check one to indicate whether fee is appropriate or inappropriate
     in relation to the University system of budgetary control.

20.  Verify account number for deposit of fee or deposit income.

21.  Complete Impact Statement.


TO BE COMPLETED BY THE PROVOST'S OFFICE:

22.  Signature of the Provost.