ADMINISTRATIVE/PROXY REQUEST ARIZONA STATE UNIVERSITY UNIVERSITY REGISTRAR’S OFFICE Department/College: Program Title: Representative Name: Request Date: Representative Phone: Fax: E-mail: Year: Semester: (Check All that Apply): Fax the Schedule/Billing Statements to the representative after the request is processed. Notify the representative when the request is processed. Forward the Schedule/Billing Statements to the Tuition Payment Office after the request is processed. (Check One) Administrative Request ** Proxy Transaction Administrative Requests are initiated by the College/Academic Unit with proper Proxy Transactions are initiated by the form, signed by the student’s proxy. A proxy authorization. An authorized signature is required. student, must be attached. ASU ID Last First Credit Course Prefix & Transaction Backdated WD F1 SLN Audit* Number Name Name Hours Number Type Date J1* Reason for transaction: Authorized Signature of College/Academic Unit Date: Registrar Office Use Only File Date (If Different From Processed Stamp: (Required for an Administrative Request): Processed Date): __________________ __________________________________________ **For Administrative Requests this form may be e-mailed to from the appropriate college designee authorized to approve administrative transactions. * Check box to indicate yes.
ADMINISTRATIVE/PROXY REQUEST ARIZONA STATE UNIVERSITY UNIVERSITY REGISTRAR’S OFFICE Department/College: Program Title: Representative Name: Request Date: Representative Phone: Fax: E-mail: Year: Semester: (Check All that Apply): Fax the Schedule/Billing Statements to the representative after the request is processed. Notify the representative when the request is processed. Forward the Schedule/Billing Statements to the Tuition Payment Office after the request is processed. (Check One) Administrative Request ** Administrative Requests are initiated by the College/Academic Unit with proper authorization. An authorized signature is required. Proxy Transaction Proxy Transactions are initiated by the student’s proxy. A proxy form, signed by the student, must be attached. ASU ID Number Last Name First Name SLN Credit Hours Course Prefix & Number Transaction Type Backdated WD Date F1 J1* Audit* Reason for transaction: Authorized Signature of College/Academic Unit (Required for an Administrative Request): __________________________________________ Date: __________________ Registrar Office Use Only File Date (If Different From Processed Date): Processed Stamp: **For Administrative Requests this form may be e-mailed to from the appropriate college designee authorized to approve administrative transactions. * Check box to indicate yes.
administrative-proxy-request_0.docx