2011 Summer Catalog - Gallaudet University
2011 Summer Catalog - Gallaudet University
2011 Summer Catalog - Gallaudet University
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32<br />
pAy m e n t in f o r m At i o n<br />
Section IV: Payment (Full payment must accompany this form. If a third-party agency is paying on your behalf, official<br />
documentation must accompany your application. You will not be enrolled in your courses if you do not send full payment. The College<br />
of Professional Studies and Outreach will contact you via email if you miscalculate the total. Please keep in mind that this will delay<br />
your registration.)<br />
FEES:<br />
<strong>Gallaudet</strong> <strong>University</strong><br />
College of Professional Studies & Outreach<br />
800 Florida Avenue, NE, HMB 141 S, Washington, DC 20002<br />
202.448-7272 (tty/v) 202.651.5987 (fax)<br />
summer@gallaudet.edu summer.gallaudet.edu<br />
Application Fee ($30) $__________<br />
Tuition $__________ (refer to course page)<br />
Materials/Lab/Test Fee $__________ (check course description)<br />
Late Fee ($50) $__________ (after the registration deadline)<br />
Board Fee* ($33/day) $__________<br />
Room Fee* ($36/night/double room) $__________<br />
Room Fee* ($72/night/single room) $___________<br />
*attach Housing/Meal Application<br />
PAYMENT TYPE:<br />
$__________ Total<br />
Check # __________________ Money Order # ______________________<br />
VR or Employer Authorization (completed paperwork must accompany this application)<br />
VISA Master Card American Express<br />
Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiration Date: ____________<br />
<strong>2011</strong> <strong>Summer</strong> <strong>Catalog</strong> • summer.gallaudet.edu<br />
Office Use Only<br />
Do not write in this box<br />
ID#_____________________<br />
Name on Card: ________________________________________________________________________________<br />
Authorized Signature: ___________________________________________________________________________<br />
Make check or money order payable to GALLAUDET UNIVERSITY and mail to it to <strong>Gallaudet</strong> to the address below.<br />
Waiver Faculty/Staff (attach signed Tuition Waiver form)<br />
Currently Enrolled Full-time <strong>Gallaudet</strong> Student (ID# __________________________)<br />
Graduate Undergraduate<br />
Consortium Student from (<strong>University</strong>): __________________________________________________________<br />
Tuition Credit (attach letter)<br />
Please check out website for changes and updates at summer.gallaudet.edu
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