TUITION RECEIPT LETTER REQUEST

$5.00 CHARGE PER SEMESTER REQUESTED

PAYMENT DUE AT TIME OF REQUEST

48-HOUR NOTICE REQUIRED

NOTE:  Letter  for the current semester will not be done until your account balance is zero.

Name:  

SID OR SSI:               

           Please print 

Date of request:      03/11/02

Year    

Request made via:  Student Office Visit

                                 Telephone (262/595-2258) request

                                 Correspondence to Cashier's Office, P.O. Box 2000, Kenosha, WI  53141

                                 Faxed to Cashier's Office at 262/595-2340

Letter(s) to be:        Picked up by student on:  DATE  morning afternoon

                                  Mailed                 Address:

Special Instructions/Phone Number where student can be reached:

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize the University of Wisconsin-Parkside to release all information to myself, pertaining to the amount of Financial Aid I received, which paid a portion of my fees for the above shown semesters.

STUDENT SIGNATURE________________________________________________DATE