Rate Code Request Form

Office of the University Bursar

To request a special tuition discount/rate code for a specific student group(s), please complete this form in its entirety with the required information.

A rate code is used for long-term discounts only. To discuss options for short term or intermittent discounts, please contact us at ESS_Fee_Assessment@nova.edu.

The Office of the University Bursar reserves the right to deny requests.

Please allow up to 5 business days for review and a response to this request.

College:

What is Program Level Code for the degree or certificate program to which the new rate code is to be applied? (i.e., H1, B1):

Desired rate code (i.e., “Broward County Employees”):

Desired rate code name:

Please provide the description for your request:

Please upload related documentation, such as an agreement, if applicable:

Include additional pertinent information to help with the rate code creation. This may include the degree or certificate program name, program code, degree code and description, field of study/major code and description, department code:

Please insert a new heading with intro sentence:

Financial Information

The following section is required to create the rate code.

Detail Code Index/Org Code/Financial Account:

How many semesters will the rate code be effective?

Estimated number of students receiving this rate code:

Will this rate code be used for more than one degree or certificate program?

Requested discount rate Enter a flat rate (e.g., $200) or percentage (e.g, 20%):

Please note: Student fees are not included in the tuition rate to be discounted.

What is the effective semester/term of this rate code?

Contact Information and Authorization

1. Name of Requester:

Phone Number:

Email Address:

2. Name of Person Authorizing the Request:

If this is the same as the requester or dean, you may leave this section blank.

Phone Number:

Email Address:

3. Name of Authorizing Dean or Designee:
(cannot be the same as the requester)

Phone Number:

Email Address:

Copies of this request will be emailed to all parties listed above. Submission of this form does not signify approval of the rate code being requested. If you have questions or need to make changes to any of the information submitted, please email ESS_Fee_Assessment@nova.edu .

Please verify that you have completed all required fields and are not a robot before submitting this form.