Fee Payment Request

Diocese of Columbus

Office of Catholic Schools

I. INFORMATION FOR THE UNIVERSITY

University (or college) where course(s) will be taken (including OSU Marion):
Quarter/Semester, Year
Last name:
First name:
Middle name:
Social Security Number (no dashes or spaces):
College or division to be attended (if in graduate school, indicate grad. only):

II. INFORMATION FOR THE DIOCESAN SCHOOL OFFICE

School:
Number of years you have taught in Diocese of Columbus (do not include current school year):
Full-Time   Part-Time
What grade level?
Were you a cooperating teacher the previous school year? Yes   No
If so, in what school?
When?
Working with student teachers?
Or early experience?
Or other (specify):
Race:
White, Not Hispanic Black, Not Hispanic
Hispanic Asian Pacific Islander
American Indian/Alaskan Native

Only third or fourth level undergrad course work and all graduate course work may be used when upgrading certificate from a provisional to a professional.

2009-2010 Fee Waiver Request Due Dates:
Fall Semester 20098-7-09ODU, Mt. Vernon Nazarene, Ashland
Winter Quarter 201010-13-09OSU, Otterbein
Spring Semester 201012-3-09ODU, Mt. Vernon Nazarene, Ashland
Spring Quarter 20101-15-10OSU, Otterbein
Summer Quarter 20103-31-10OSU, Otterbein
Summer Semester 20104-1-10ODU, Mt. Vernon Nazarene, Ashland
Fall Quarter 20106-15-10OSU, Otterbein

The Columbus Catholic Schools have exchange of service agreements with the following colleges/universities: ODU, OSU, Ashland University, Mt. Vernon Nazarene University, and Otterbein College.