Social Security Certification For Credit Tuition Waiver Form


Social Security Certification For Credit Tuition Waiver Form
I certify that the above-named individual is out of the workforce as a result of a permanent
disability and is receiving a social security disability benefit (SSDI) or supplemental security
income (SSI) as defined by the Social Security Act, Railroad Retirement Act, or in the case of a
former federal employee, the federal retirement or pension authority (U.S. Office of
Personnel Management).
Individuals receiving SSI or SSDI benefits as a dependent or survivor of a disabled beneficiary
do not qualify for this waiver.
Place Office Stamp in Box
Printed Name & Title of Certifying Official
Signature of Certifying Official
Phone Number of Certifying Official
Student Signature
Student Signature authorizes the Social Security Administration (Railroad Retirement Board, or
U.S. Office of Personnel Management) to release information on the above named individual
and acknowledges that this form is valid for one academic year and must be renewed each
academic year. In addition, student acknowledges that he/she must apply for financial aid.
Return ORIGINAL completed form with signature and stamp to the Cashier's Office:
Cashier's Office (Student Services Center, 1st Floor)
Anne Arundel Community College
101 College Parkway
Arnold, MD 21012


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