Nonresident Tuition Fee Waiver Application (workflow)

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Chaffey College

Nonresident Tuition Fee Waiver Application

Chaffey College Board Policy 5020 states that, “Nonresident students shall be charged nonresident tuition for all units enrolled, unless specifically required otherwise by law." It further states that, "Students who would otherwise be charged this fee shall be exempt if they demonstrate that they are a victim of persecution or discrimination in the county of which they are a citizen and resident, or if they demonstrate economic hardship.

Students shall be deemed victims of persecution or discrimination if they present evidence that they are citizens and residents of a foreign country and that they have been admitted to the United States under federal regulations permitting such persons to remain in the United States.

Students shall be deemed to have demonstrated economic hardship if they present evidence that they are citizens and residents of a foreign country and that they are receiving Temporary Assistance for Needy Families Program, Supplemental Income/State Supplementary benefits, or general assistance. Exemptions may be made on an individual basis, and not more than 10 percent of the nonresident foreign students attending the District may be so exempted through this provision."

This form will be used to determine if you meet the exemption requirements established by this policy. If these guidelines apply to you, please complete this form in its entirety and attach the required documentation.

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 (legal status that allows you to live and work in a country on a permanent basis) in the United States: *

Yes No

2. I am deemed a victim of persecution or discrimination admitted into the United States under federal regulations permitting such persons to remain in the United States*

Yes No

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

Yes No

Reason for Petition

Please only select ONE of the following reasons:*

I am registered in 6 (six) units or less I am experiencing economic hardship

Please make sure to only select one option, choosing more than one option may result in a denial.

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.

Please note that income and family size are correlated according the Federal Poverty Guidelines. If your income exceeds the Federal Poverty Guidelines income limit shown to the right, you will not meet the economic hardship criteria for this waiver and your application will be denied. If your income exceeds the corresponding family size, you may choose to close this form and not submit it. You may reach out to Admissions and Records to identify other potential sources of support for your situation.

Select Your Family Size Based on Income Tax Eligible Dependents*

Select Your Family Size Based on Income Tax Eligible Dependents
	Select Below
Family Size of 1 - Income May Not Exceed $21,870	Select Your Family Size Based on Income Tax Eligible Dependents: Family Size of 1 - Income May Not Exceed $21,870 (Select Below)
Family Size of 2 - Income May Not Exceed $29,580	Family Size of 2 - Income May Not Exceed $29,580 (Select Below)
Family Size of 3 - Income May Not Exceed $37,290	Family Size of 3 - Income May Not Exceed $37,290 (Select Below)
Family Size of 4 - Income May Not Exceed $45,000	Family Size of 4 - Income May Not Exceed $45,000 (Select Below)
Family Size of 5 - Income May Not Exceed $52,710	Family Size of 5 - Income May Not Exceed $52,710 (Select Below)
Family Size of 6 - Income May Not Exceed $60,420	Family Size of 6 - Income May Not Exceed $60,420 (Select Below)
Family Size of 7 - Income May Not Exceed $68,130	Family Size of 7 - Income May Not Exceed $68,130 (Select Below)
Each Additional Family Member Beyond 7, Add $7,710 to the Amount Above	Each Additional Family Member Beyond 7, Add $7,710 to the Amount Above (Select Below)

2023 Income Based on 2023 Income Tax Submission Documents *

2023 Income Based on 2023 Income Tax Submission Documents
	Select Below
$21,870	2023 Income Based on 2023 Income Tax Submission Documents : $21,870 (Select Below)
$29,580	$29,580 (Select Below)
$37,290	$37,290 (Select Below)
$45,000	$45,000 (Select Below)
$52,710	$52,710 (Select Below)
$60,420	$60,420 (Select Below)
$68,130	$68,130 (Select Below)
+ $7,710	+ $7,710 (Select Below)

Please Select *

None of the incomes listed above apply to me. If you select this option, you must provide verification that your family has no earned income such as the situations described at the top of this form. Incomes listed above apply to me. If you select this option, you must provide supporting documentation.

Please upload documents verifying economic hardship;*

No File Chosen

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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.

Por la presente juro o declaro, bajo pena de perjurio, que toda la información en este formulario es verdadera y completa según mi leal saber y entender. Si falsifico información en este formulario, seré responsable de reembolsar a el colegio cualquier cantidad adeudada por concepto de matrícula para no residentes, y estaré sujeto a medidas disciplinarias estudiantiles, que pueden incluir la suspensión y/o expulsión del Distrito.

Which group does the first letter of your last name fall under?*

A-M N-Z

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

Comments:

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