Ab540 Affidavit printable pdf download

California Nonresident Tuition Exemption Request

For Eligible California High School Graduates

Complete and sign this form to request an exemption from Nonresident Tuition. You must submit any documentation

required by the College or University (for example, proof of high school attendance in California). Contact the California

Community College, University of California or California State University campus where you intend to enroll (or are

enrolled) for instructions on documentation, additional procedures and applicable deadlines.

ELIGIBILITY:

I, the undersigned, am applying for a California Nonresident Tuition Exemption for eligible California high school

graduates at (

and I declare the following:

specify the college or university)____________________________________________

Check YES or NO boxes:

Yes

I have graduated from a California high school or have attained the equivalent thereof, such as a

High School Equivalency Certificate, issued by the California State GED Office or a Certificate of

Proficiency, resulting from the California High School Proficiency Examination.

Yes

I have attended high school in California for three or more years.

Yes

I am NOT a nonimmigrant alien (including, but not limited to, a U.S. citizen, permanent resident,

or an alien without lawful immigration status).

Provide information on all school(s) you attended in grades 9 - 12:

School

City

State

Dates:

From – Month/Year

To – Month/Year

Documentation of high school attendance and graduation (or its equivalent) is required by the University of California,

The California State University and some California Community Colleges. Follow campus instructions.

Check the box if it applies to you:

I am a nonimmigrant alien as defined by federal law, [including, but not limited to, a foreign student (F visa),

exchange visitor (J visa), visitor (B1-B2 visa)].

AFFIDAVIT:

I, the undersigned, declare under penalty of perjury under the laws of the State of California that the information I have provided on this form is true and

accurate. I understand that this information will be used to determine my eligibility for the nonresident tuition exemption for eligible California high school

graduates. I hereby declare that, if I am an alien without lawful immigration status, I have filed an application to legalize my immigration status or will file

an application as soon as I am eligible to do so. I further understand that if any of the above information is untrue, I will be liable for payment of all

nonresident charges from which I was exempted and may be subject to disciplinary action by the College or University.

Print Full Name (as it appears on your campus student records)

Campus/Student Identification Number

Print Full Mailing Address (Number, Street, City, State, Zip Code)

Email Address (Optional)

Phone Number (Optional)

Signature

Date