Graduate Student Tuition/Fee/Fellowship Payment Memo Submission
Please submit your Graduate Student payment memos through this form.
I am a...
*
Student
Staff/ Faculty Member
Back
Next
Staff/Faculty Member Name
*
First Name
Last Name
Email
*
example@example.com
Department
*
Student Name
*
First Name
Last Name
UA ID
*
Student Email
*
example@example.com
Applicable Semester
*
Spring 2024
Summer 2024
Fall 2024
Spring 2025
Summer 2025
Memo includes TUITION
*
Yes
No
Memo includes FEES (The memo should include "up to" dollar amounts for fees)
*
Yes
No
Memo includes GRADUATE STUDENT HEALTH INSURANCE
*
Yes
No
Back
Next
Tuition
Amount of Credits Awarded
*
If none list 0
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:
*
All Fees (excluding late fees, parking, P.O. Box, and housing fees)
Surcharges (CEM/SOM)
Late Payment Fees (Excludes late rental payments)
Other
Graduate Student Health Insurance
Applicable Term
*
Fall Semester
Spring/Summer Semesters
Summer Semester Only
Student Phone Number
*
-
Area Code
Phone Number
Student Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Biological Sex (Required by Insurance Company)
*
Male
Female
Intersex
Student Birthday
*
-
Month
-
Day
Year
Date
Back
Next
Payment Details
Exemption Code
*
Detail Code
*
Upload your Memo
Upload Document:
*
Browse Files
PDF files only
Cancel
of
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.
*
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.
*
I Agree
Submit
Should be Empty: