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:

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 = $19,904
Less than 12 credits = $1,327 per credit
Over 18 credits = $19,904 + $1,327 per credit over 18).
$

Adjusted Payment Due:

$ 0