Graduate Student Tuition/Fee/Fellowship Payment Memo Submission
Please submit your Graduate Student payment memos through this form.
I am a...
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Student
Staff/ Faculty Member
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Staff/Faculty Member Name
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First Name
Last Name
Email
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example@example.com
Department
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Student Name
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First Name
Last Name
UA ID
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Student Email
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example@example.com
Applicable Semester
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Fall 2020
Spring 2021
Summer 2021
Memo includes TUITION
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Yes
No
Memo includes FEES
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Yes
No
Memo includes GRADUATE STUDENT HEALTH INSURANCE
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Yes
No
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Tuition
Amount of Credits Awarded
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Specific Tuition Amount Awarded
Notes regarding tuition award:
(i.e. to be used for specific classes, requirements for reward, etc.)
Fees
Check all that apply:
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All Fees (excluding late fees, parking, P.O. Box, and housing fees)
Surcharges (CEM/SOM)
Late Payment Fees (Excludes late rental payments)
Graduate Student Health Insurance
Applicable Term
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Fall Semester
Spring/Summer Semesters
Summer Semester Only
Student Phone Number
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-
Area Code
Phone Number
Student Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Biological Sex (Required by Insurance Company)
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Male
Female
Intersex
Student Birthday
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-
Month
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Day
Year
Date
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Payment Details
Exemption Code
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Detail Code
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Upload your Memo
Upload Document:
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Memo Submission Agreements
I understand that my student loans or other federal aid may be reduced as a result of the tuition and/or fee support in this memo and its impact on my cost of attendance.
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I Agree
I understand that I am fully responsible for any balance due and/or any late fees that are accrued for failure to pay the balance by the fee payment deadline.
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I Agree
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