THE UNIVERSITY OF TEXAS
AT SAN ANTONIO
SCHOLARSHIP/LOAN VOUCHER
PAY TO:
Social Security Number: ____________________
RESIDENCY STATUS: (Check One)
UTSA VOUCHER NO. _________________
_____Resident
DATE VOUCHERED: __________________
_____Nonresident (Not a Texas resident,
but a resident of the United States)
_____Foreign
CHECK NO. __________________________
DATE OF CHECK: ____________________
DESCRIPTION OF SCHOLARSHIP/LOAN
____________________
RECEIPT NO.
____________________
CASHIER
ACCOUNTS TO BE CHARGED
Account Title
Account Number
POSTED MACHINE
POSTED OTHER RECORDS
STUDENT CERTIFICATION
Amount
_________________
DATE
Encumbrances
Loan No.
Estimated Cost
Expenditure Classification
Code No.
Amount
CHECKED
AGENCY CERTIFICATION
I certify that the above named student has met all criteria required to receive
this award and that the amount is true, and unpaid.
I, __________________________________________________________ do
Hereby certify that the voucher is correct and that it corresponds in every
particular with the scholarship/loan. I further certify that the amount is true,
correct, and unpaid.
______________________________________________________________________
FOR DEPARTMENT
______________________________________________________________________
FOR FINANCIAL AID
DATE APPROVED FOR PAYMENT_______________________________________
_____________________________________________________________________
Student's Signature
FOR OFFICE OF ACCOUNTING
______________________________________________________________________
FOR DIRECTOR OF ACCOUNTING