Multiplex Reservation Form

Name(Required)

First Last

Student ID Number

Email(Required)

Enter Email Confirm Email

Phone Number(Required)

Which facility would you like to reserve?(Required)

Basketball Court

Racquetball Court

Cinema

Which date would you like to reserve?(Required)

What time would you like to reserve?(Required)

How many hours would you like to reserve the facility?(Required)

I understand that the date and time I requested are not guaranteed and must be approved by a staff member. I understand that I will be notified at the email address provided on this form regarding my reservation request.(Required)

I agree

Online Payments Portal

Phone
This field is for validation purposes and should be left unchanged.
Online Payments
Are you a current student?*
Faulkner Student ID Number*
Enter ID Number
######*
Confirm ID Number
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Personal Phone*
Work Phone
Email*
Payment Information
Payment Description*
Social Security Number*
Date of Citation*
MM slash DD slash YYYY
License Plate Number*
Location of Violation*
Date of Citation*
MM slash DD slash YYYY
License Plate Number*
Location of Violation*
Report Number*
Please select your status*
- New student/transfer student
- Returning student
Quantity of Transcripts Requested @ $30/ea.*
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Would you like to put down the payment for your tool kit today and have your equipment by the first day of class?*
This will save you 3% percent fee at a later date. This tool kit is mandatory.
Tool Kit Deposit*
Price:
This will be added to the $500 DPT Deposit.
NOTE: Not paying for the mandatory tool kit with your DPT Deposit will result in a 3% convenience fee.

To pay for your Tool Kit at a later date, return to this Payment Portal, and pay $110 dollars via the 'Other' payment option.
Name of Child in Pre-K*
First Name Last Name
Graduation Month
Graduation Month*
Graduation Year*
Please Note: This form does not apply to J.D. or LL.M. graduates. For more information, please refer to J.D. and LL.M. graduation information or email Dean DeBoer (jdeboer@faulkner.edu) any questions.
Note: This fee is non-refundable except in the event that the program fails to receive accreditation.
Other Payment Description*
Law School Organization Name*
Please Note: This is a payment portal only. To complete a transcript request application, visit the Transcript Request section of the Registrar page and follow the instructions.
Please select your deposit amount*
- $200 refundable deposit (until May 1 of entry year)
- $1000
- Other
Amount*

Minimum of $5.00 required.
Other Amount*
3% Convenience Fee
Price: $0.00
3% Convenience Fee
Price: $0.00
Amount*

Please note that if this graduation application payment is late, you will need to pay an additional $50.
How should this be applied?
- Student's trip
- Mission Trip Fund
Please list the student:
3% Convenience Fee
Price: $0.00
Total
$0.00
The graduation application is closed. Please refer to https://faulkner.edu/student-life/registrar/ for more information.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Untitled

First Name	Last Name