MANCHESTER COMMUNITY COLLEGE



Credit-Free Programs Request for Payment Form

MANCHESTER COMMUNITY COLLEGE

REGISTRATION SERVICES

PO BOX 1046 - MS#13

MANCHESTER, CT 06045-1046

To: Continuing Education Credit-Free Instructors

From: Arlene Paterwic, Fiscal Administrator

Re: Payment Request Form - Credit-Free Course

You must complete and return both a grade roster and this payment request form before your payment can be processed.

I hereby certify that I have completed instructing:

CRN# Course Title

(course number)

__________ _____________________________________________________

for the dates and hours listed below, have completed and enclosed the grade roster

for this class and request that the payment process be initiated.

Date(s) Taught Number of Hours

Signature:___________________________________ Date:________________

Please print name:_____________________________

Return completed grade roster and payment request form to:

Manchester Community College

Registration Services

PO Box 1046 - MS # 13

Manchester, CT 06045-1046

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