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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

Student Name*
Date of Birth *
Address*

Eligibility: Please read  carefully and answer the following questions;

1. My immigration status currently prevents me from establishing residency in the United States: *
2. I am in the United States under a current "F" , "J", or "M" Visa:*
3. Can you provide proof that you are a resident of California? *

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
2
3
4
5
6
7
Each Additional Family Member
2021 income
2021 income
  Select Below
12,880
$17,420
$21,960
$26,500
$31,040
$35,580
$40,120
$4,540
Please Select *
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.

Use your mouse or finger to draw your signature above
Date*
Use your mouse or finger to draw your signature above
Date*

Residency Advisor

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

Executive Director: Admissions & Records

Student Status *
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Date/Time*

Cashier Coordinator: Admissions & Records

Rebill Status *
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