New Laboratory/Class Charge Form
Person submitting request:
*
First Name
Last Name
Your email
*
example@example.com
Department/School
*
Chair/Director's email:
*
example@wiu.edu
Dean's email:
*
example@wiu.edu
Purpose of the requested charge:
*
Details:
*
Rows
Please indicate:
All funds assessed through this charge shall be placed in local account #:
Proposed charge per student:
Number of students to be enrolled per academic year:
Projection of the total amount of income generated per year:
List course(s) that this new laboratory/class change will affect:
*
List course(s) that this new laboratory/class change will affect:
*
Effective Start Term
*
Please Select
Fall
Spring
Summer
Start Year
*
Submit
Should be Empty: