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Institute of Global Education Graduate Student
Cooperative
Payment Form
TO:
Karla Gulke, Accounting
IGE Student Cooperative,
P. O. Box 896,
Friday Harbor, WA 98250
Email to igecoop@
(360) 378-5453 (emergencies only)
(360) 378-6313 IGE OFFICE
All checks etc should be made payable to the Institute of Global
Education
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FORM SYNOPSIS: ____________(date)
This form is in regard to a
( ) Payment of $_______________ by [__check credit card, etc__]
for [__tuition, course, book,
bill etc__] by (your name)___________________
( ) Bill for $_________________ from ( ) IGE Accounting (
) other_____________
for __(purpose)__________________
( ) Credit for $_________________ concerning:_______________________________
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( ) FROM (payment submission)
or
( )TO: (amount due)
Name,
Address,
Zip
Telephone,
Email address
( ) Master's Program
( ) Ph.D Program
( ) Other_____________________
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**********************************************************************
AMOUNT DUE:
STATEMENT STATEMENT STATEMENT STATEMENT
STATEMENT STATEMENT
Name of the person who is issuing the statement:________________
Role________________
Date:_______________________
( ) The following payment is due:
$__________________This amount is presently due for
( )Semester tuition: Semester dates______Number of Credits
______ Fee/Credit________.
( )Course payment ECO______ Date taken________Credits ______Fee/Credit________.
Other (Please describe)
Additional Information:
**********************************************************************
**********************************************************************
AMOUNT PAID:
PAYMENT PAYMENT PAYMENT PAYMENT PAYMENT
PAYMENT PAYMENT
( ) ENCLOSED IS PAYMENT FOR APPLICATION OR TUITION :
( ) Application fee payment $60.00 by
( ) check
( ) PayPal (accepts most credit cards at pay station located
below this form)
For information visit PayPal page http://www.ecopsych.com/apppaypal.html
)
( ) 0ther_________________
( ) Tuition for semester commencing (date) :
________Total number of credits being taken for the semester
(minimum 6, maximum 15-18, First semester payment is for15 credits
that may be taken at any time at IGE)
$________ My officially assigned cost/credit that is on file
with accounting.
[as described at:
Masters http://www.ecopsych.com/apptuitionms.html
Doctoral http://www.ecopsych.com/apptuitionphd.html
]
$________Tuition amount enclosed
All checks etc should be made payable to the Institute of Global
Education
The following are this semester's Course Identifications and
number of credits
(Example: Course name/number ECO 500 Orientation Credits 1
)
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
Course name/number___________________Credits__________________
( ) ENCLOSED IS PAYMENT FOR FOR AN INDIVIDUAL COURSE OR OTHER
SERVICE(S):
All checks etc should be made payable to the Institute of Global
Education
Course Identification and number of credits (example ECO 500
1credit)
$________ My officially assigned cost/credit
$________Other services;
Prior Learning Evaluation @ $30/ topic:
Transfer Courses @ $20/credit:
Books:
Other:
RECEIPT be sure to retain and file this record.
( )Please email me a copy of this payment form as a receipt.
( ) A stamped, self-addressed return envelope is enclosed
along with two hard copies of this form. Please send me a hard
copy of this form as my receipt
( ) CREDIT STATEMENT:
Please credit my account for $__________ that has been authorized
for my completion of a WORK/STUDY or other contract with regard
to:
Authorized by:
Faculty, Guide or Coordenating Committe Member.
Karla Gulke, Accounting
IGE Student Cooperative,
P. O. Box 896, Friday Harbor, WA 98250
Email to igecoop@
(360) 378-5453 (accounting emergencies only)
(360) 378-6313 IGE cooperative office
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