(This exemption waiver is 50% of the general service fee for the in-state portion of the fees. Special fees and non-credit courses taken through Continuing Education are not included)
NAME: DATE: ADDRESS: PHONE NO.: STATE OF RESIDENCE: *SOC. SEC.#: DATE OF BIRTH: SEMESTER NUMBER OF HOURS THIS SEMESTER: HIGH SCHOOL GRADUATION/GED DATE:
I certify by signing below that: I am retired, not employed on a full-time basis, I am sixty (60) years or older, and the above information is correct.
APPLICANT SIGNATURE DATE
In order to receive the tuition exemption, you must complete this form and return to the Registrar's Office, Schwarz Hall, Room 40.
*NOTE: In accordance with the Privacy Act of 1974, students are advised that the requested disclosure of their social security number is voluntary. It is recommended that the social security number be used as the student ID number to avoid assignment of a special nine digit number which must be retained for the duration of the student's dealings with the University. The social security number will be used to identify the permanent records of the student such as registration, drop/add, transcript requests, certification requests, and as an identification for grants, loans, and other financial aid programs; and including determining eligibility, certifying school attendance and student status.