Non-Resident Fee Waiver

NON-RESIDENT FEE WAIVER

Applicant Name:    Applicant Address:

Institution/Agency Name:    Program/Service:

WHEREAS

WHEREAS, Applicant represents that Applicant is a non-resident with respect to the jurisdiction of the Institution and is not liable for resident tuition or fees by reason of physical residency; Jurisdiction: ;

WHEREAS, the Institution has authority to grant a temporary or conditional waiver of specified fees under the Institution's policies and applicable law; and

WHEREAS, Applicant requests a waiver of specified fees and submits documentation in support of non-resident status and financial or programmatic hardship as applicable.

SCOPE OF WAIVER

PAYMENT TERMS

Fee(s) waived (amount):    Fee description:

Remaining fees payable by Applicant, if any (amount):

Late payment charge: (applies to amounts not timely paid in accordance with the payment schedule).

TERM AND TERMINATION

Effective Date:    Expiration Date:

This waiver shall remain in effect for the period indicated above unless earlier terminated in accordance with this section. Either party may terminate this waiver for cause upon written notice to the other party. Notice period (days):

CONDITIONS AND DOCUMENTATION

Applicant certifies that all statements and documents submitted in support of this waiver are true and complete. Applicant understands that any material misstatement may be grounds for denial or revocation of the waiver and recovery of waived amounts.

Passport or travel document     Visa or residency permit     Affidavit of non-residency     Other:

CONFIDENTIALITY

Except as required by law or institutional policy, the Institution shall treat information submitted in support of this waiver as confidential and shall not disclose it to third parties without the Applicant's consent. Notwithstanding the foregoing, the Institution may disclose information to auditors, accrediting bodies, or as required by legal process.

GOVERNING LAW

This Fee Waiver Agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction of: , without regard to its conflict of laws principles.

ENTIRE AGREEMENT

This document constitutes the entire agreement between the parties concerning the waiver of the fees described herein and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral, relating to the subject matter of this waiver. Any modification must be in writing signed by both parties.

CERTIFICATION

By signing below, Applicant certifies that Applicant has read and understands the terms of this Non-Resident Fee Waiver, that the information provided is true and accurate, and that Applicant agrees to comply with any conditions or repayment obligations set forth herein. The Institution's signature constitutes institutional approval of the waiver subject to any conditions stated above.

Sign Now