Billing Web Forms
Account Correction Worksheet
Your First Name:
Your Last Name:
Email Address:
Affiliation:
Student
Parent
Student's First Name:
Student's Last Name
Student's Middle Initial:
Goucher ID#:
Semester:
Choose One
Spring 2013
Fall 2013
Spring 2014
Fall 2014
Spring 2015
Fall 2015
Spring 2016
Fall 2016
Amount due on Statement:
$
Adjustments:
(Indicate if a plus or minus.
Enter a numeric value in each field, even if 0.)
Explanation:
Meal Plan Change
$
Financial Aid
$
Other Scholarships/Awards
$
Other
$
Tuition Adjustment
(12 - 18 credits = $19,231
Less than 12 credits = $1,282 per credit
Over 18 credits = $19,231 + $1,282 per credit over 18).
$
Adjusted Payment Due:
$ 0
