Request for Extension Foundation to Collect Fees for Online Courses

Request for Extension Foundation to Collect Fees for Online Courses

Course Teacher / Coordinator
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Course(s) and Fee(s)
Please identify the course(s) and fees associated with each course if known. For unknown courses, or future courses not identified, please see the agreement below.
Agreement

Fees collected for courses or events offered through campus.extension.org shall be deposited with the Extension Foundation. Unless otherwise governed by a separate institutional or course-specific agreement, the Extension Foundation shall retain ten percent (10%) of registration fees, net of applicable credit card and transaction fees. The Extension Foundation will receive, process, and distribute such fees in accordance with the Foundation’s Terms of Use - Special Circumstances.

Current and Future Courses

This agreement applies to the course(s) identified at the time of execution and to any additional, future, or subsequently developed courses offered by the Course Instructor/Coordinator through the Extension Foundation during the term of this agreement. All such courses shall be subject to the same terms, conditions, and fee structure unless modified by written amendment executed by both parties.

Term

This agreement shall remain in effect for one (1) year from the date of final execution, unless earlier terminated by either party upon written notice.
Coordinator Signature*

Clear
Date*

MonthDayYear
Date
Funds Distribution
Name of Institution*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Fiscal Representative Information
Fiscal Representative Name*

First NameLast Name
Fiscal Representative Title*
Fiscal Representative Email*
example@example.com
Upon clicking "Submit" below, an email will be sent to the Fiscal Representative identified above asking for their approval and signature. Upon approval, both you and the fiscal representative will each receive a signed PDF of this agreement.

Please contact campusadmin@extension.org for any question.
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Request for Extension Foundation to Collect Fees for Online Courses

Funds Distribution

Fiscal Representative Information