Tuition Waiver Application Form

Tuition Waiver Application Form

Use this form to request a waiver of tuition charges for the specified academic term. Submission of this application authorizes the educational institution to verify information provided herein. Approval is discretionary and conditional upon verification of eligibility criteria, fund availability, and institutional policy. False statements or failure to report changes in eligibility may result in repayment, disciplinary action, or withdrawal of the waiver.

Student Information

Student Name:

Date of Birth:    Student ID:

Parent / Guardian Information (if applicant is a minor)

Applicant is under age 18:

Enrollment Term and Tuition

Academic Term:    Start Date:    End Date:

Enrollment Status: Full-time    Part-time

Waiver Requested

Waiver Type Requested:
Full tuition waiver
Partial tuition waiver — Amount requested:
Waiver of mandatory fees (specify in supporting documents)
Other (describe below)

Basis for Waiver (check all that apply):
Financial need   Academic merit/scholarship   Employee/Dependent benefit
Veteran or military benefit   Disability accommodation   Other

Financial and Household Information

Academic Eligibility

Program Status: Continuing student    Newly admitted

Certification and Authorization

By signing below, I certify that all information provided on this application and in any supporting documentation is true, complete, and correct to the best of my knowledge. I understand that the institution may verify any information provided and may require additional documentation. I authorize release of academic and financial information to authorized personnel for the purpose of evaluating this waiver request.

I understand that any waiver awarded is limited to the specific charges approved and does not automatically apply to subsequent terms unless expressly renewed. I further understand that the waiver may be rescinded or reduced if eligibility changes, if information provided is found to be false or misleading, or if funding is unavailable. In the event of fraud or misrepresentation, I may be required to repay waived amounts and may be subject to disciplinary or legal action.

Applicant consents to the institution contacting third parties, including employers, financial institutions, and governmental agencies, for the purpose of verifying information relevant to this application.

I certify that I have read and understand the terms above and that the information provided is true and correct.

Institution Use Only

Approved    Denied    Pending / Further Review

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