CTC & CSET Invoice

TO:

DATE:

FROM:
DR. CAROL FRY BOHLIN
MATHEMATICS AND SCIENCE TEACHER INITIATIVE (MSTI)
CALIFORNIA STATE UNIVERSITY, FRESNO
5005 NORTH MAPLE AVENUE M/S ED 2
FRESNO, CA 93740-8025

_______________________
______________________________________
(NAME) (Please Print)
______________________________________
(STREET)
______________________________________
(CITY) (STATE) (ZIP)
_____________________________________
(FRESNO STATE STUDENT I.D. NUMBER)

Date(s) of Last CSET Exam(s) Taken: ____________________________________________
___________________________________________________________________________

Description of Service Provided

REIMBURSEMENT FOR CALIFORNIA COMMISSION ON TEACHER
CREDENTIALING APPLIED and/or CSET EXAM TAKEN ON:        ​AMOUNT

________________________________________________ ________________
________________________________________________ ________________
________________________________________________ ________________
________________________________________________ ________________

*TOTAL* ________________

CERTIFICATION:

I CERTIFY THAT THIS IS A TRUE AND JUST INVOICE FOR WHICH PAYMENT HAS NOT BEEN RECEIVED
________________________________________ (P​AYEE’S SIGNATURE)

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