Third-Party Contract (TPC)

Sponsor's Billing and Contact Information:

Organization Name: *

Billing Address: *

City, State, Country: *

Postal Code: *

Billing Contact Information:

Full Name: *

Title: *

Phone, with international codes: *

Fax, with international codes: *

Email: *

Student Information:

First Name: *

Last Name: *

UW Student ID#: *

Please select the academic terms for which your organization will sponsor this student:

Academic Quarter: *

Summer 2009

Autumn 2009

Winter 2010

Spring 2010

Tuition (Select one):

Full Tuition

Partial tuition up to $, enter amount below

Standard Fees:

Course Fees

Health Insurance

U-Pass (bus pass)

Orientation Fees

Addidtional fees that your student may incur:

Transcripts

UW ID card replacement fee

Late Registration Fees

Late Change Fee (changes made to registration after 7th day of the quarter)

Late Payment Fee

Student Fiscal Services