Application For Regents Waiver Of Nonresident Tuition Fees printable pdf download

Application for Regents’ Waiver of Non-resident

Tuition Fees for International Students

International Student

Admissions & Advising

Deadline Dates:

FOR OFFICE USE ONLY

555 North Indian Creek Drive

Fall Semester

July 30

Date Received________________

Clarkston, GA 30021

Spring Semester

December 3

Campus_____________________

Summer Semester

April 14

Received By

COMPLETE AND RETURN THIS FORM TO THE OFFICE OF INTERNATIONAL STUDENT ADMISSIONS AND

ADVISING, OR TO THE CAMPUS ENROLLMENT AND REGISTRATION SERVICES OFFICE BY THE POSTED

DEADLINE.

Please print clearly

Reason for waiver (check one)

Academic

International

Special Circumstance

Peer Assistant

Georgia State University

Georgia Tech Language

Mercer University

Final Level

Institute Level 700

Level 6

Applying for (check one)

Fall

Spring

Summer

Campus Attending (check one)

Alpharetta

Clarkston

Decatur

Dunwoody

Newton

Name of Applicant___________________________________________________________________________ Student ID Number___________________________

Country of Citizenship________________________________________________________________________ Current Visa Type____________________________

Local Mailing Address____________________________________________________________________________________________________________________

Local Phone Number______________________________________ Email Address: __________________________________________________________________

Name and Phone Number of Sponsor. (If F1)__________________________________________________________________________________________________

Major________________________________ Anticipated Graduation Date________________________________

Cumulative Grade Point Average (GPA) ________________________________ Hours Earned _________________

Are you employed?

Yes

If yes, name and location of employer ________________________________________________________________________________________________________

Have you held a ‘Regents’ Waiver of Non-resident Fees in the past?

Yes

If yes, for what terms? ______________________________________________

Are you receiving a scholarship from Georgia Perimeter College or any other source

Yes

If yes, what type of scholarship? ____________________________________________________________________________________________________________

List all committees/organizations you are serving on and the amount of money awarded to you each semester for participation__________________________________

For Georgia Tech, Mercer, and Georgia State Language Institute Applicants only

This section must be certified by an

administrator at the Language Institute

Highest Level Completed________________ Average Grade________________

Date Completed or anticipated completion date_____________ Certified by_________________________________________ Title______________________

Phone Number______________________________________ Email Address: _________________________________________________________________

I acknowledge that I have read and understand the guidelines concerning the Waiver of Non-resident Fees for International Students. I certify that the information given

is correct to the best of my knowledge, and I understand that failure to give accurate and complete information may invalidate this application.

Signature_____________________________________________________________

Date__________________________________

Revised on 04/29/2009