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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