Nonresident Tuition Fee Waiver Application (workflow)

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Chaffey College

Nonresident Tuition Fee Waiver Application

CCCD Board Rule 8100.15 states that “students who are citizens and residents of a foreign country, or who are legally precluded from establishing residency in California, shall be entitled to exemption from nonresident fees on the basis of individual financial need in accordance with regulations adopted by the Chancellor. Such individual exemptions shall not be granted in excess of ten percent (10%) of the District’s students who are both citizens and residents of a foreign country in the applicable term. If you meet the eligibility requirements on the Nonresident Tuition Fee Waiver Affidavit you may be eligible to receive a nonresident tuition exemption.

This form will be used to determine if you meet the exemption requirements established by this policy. If these guidelines apply to you, please fill out this form for the Admissions and Records Office at your college.

Student Information

Term*

Year *

Student Name*

First Name

Last Name

Chaffey ID Number*

Date of Birth *

Age*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Chaffey Email*

Phone*

Eligibility: Please read carefully and answer the following questions;

1. My immigration status currently prevents me from establishing residency in the United States: *

Yes No

2. I am in the United States under a current "F" , "J", or "M" Visa:*

Yes No

3. Can you provide proof that you are a resident of California? *

Yes No

Please Read:

You are not eligible for this waiver except in circumstances of documented severe economic hardship.

Please submit income information to establish economic hardship.

Family Size

Family Size
	Select Below
1	Family Size: 1 (Select Below)
2	2 (Select Below)
3	3 (Select Below)
4	4 (Select Below)
5	5 (Select Below)
6	6 (Select Below)
7	7 (Select Below)
Each Additional Family Member	Each Additional Family Member (Select Below)

2021 income

2021 income
	Select Below
12,880	2021 income: 12,880 (Select Below)
$17,420	$17,420 (Select Below)
$21,960	$21,960 (Select Below)
$26,500	$26,500 (Select Below)
$31,040	$31,040 (Select Below)
$35,580	$35,580 (Select Below)
$40,120	$40,120 (Select Below)
$4,540	$4,540 (Select Below)

Please Select *

None of the incomes listed above apply to me. Incomes listed above apply to me.

Please upload proof of taxes below;*

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These standards are based upon the federal poverty guidelines, as published each year by the US Department of Health and Human Services. Under Title 5 of the California Code of Regulations, the student or student’s family must have a total income in the prior year that is equal to or less than 150% of the U.S. Department of Health and Human Services Poverty Guidelines based on family size.

Applicant Certification: Please Read & Sign Below

I hereby swear or affirm, under penalty of perjury, that all the information on this form is true and complete to the best of my knowledge. If I falsify information on this form, I will be responsible for reimbursing the college for any nonresident tuition fees owed, and I will also be subject to student discipline, up to and including suspension and/or expulsion from the District.

Student Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

Parent Signature (required for dependent students under age 19)*

[clear]

Use your mouse or finger to draw your signature above

Date*

Residency Advisor

The following student has been confirmed for non citizenship status.*

Approved Denied

Executive Director: Admissions & Records

Student Status *

Approved Denied

Please state reason below*

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Cashier Coordinator: Admissions & Records

Rebill Status *

Done