| |
NAME (Please Print) ______________________________________________________________ |
| NET I.D. _________________ PHONE NUMBER (Day)____________________________________ |
| ADDRESS_______________________________________________________________________ |
| _______________________________________________________________________________ |
| |
UNITS REQUESTED __________ QUARTER (cirle one) SUMMER FALL WINTER SPRING |
| |
|
Enrollment Fees |
_______________ |
| Late Enrollment Fees |
_______________ |
| Miscellaneous Course Fees |
_______________ |
| TOTAL FEES |
_______________ |
| Subtract* |
(_______________) |
| |
*Circle one: University Account Balance • Amount
Paid by Sponsor |
| |
BALANCE DUE |
_______________ |
Mail worksheet and payment to: |
| Cal State East Bay Accounting Office; WA 645; Hayward; CA; 94542-3024. Or place in Cashier’s drop box at Warren Hall,
first floor lobby. |
