2021-22 Graduate Application for Admission
Diversity Program Participation
Fee Waiver Verification Form
Last Updated 10/22/19
Applicant Instructions:
1) Confirm participation in an eligible program: http://gradfeewaiver.stanford.edu
2) Complete the Applicant Information and Program Director Information sections below
3) Obtain the signature of the Program Director
4) Uploaded a scan (PDF or JPG) of the signed form as part of the fee waiver application (forms without a
signature will not be accepted). If you cannot obtain a signature, please include a PDF of email from
the program director verifying your participation.
Eligible Program Information
Program Name (drop down menu):
Most recent academic year of program participation/funding:
Applicant Information
Full Name:
Stanford Department Applied to:
Email address:
Phone Number:
Undergraduate Institution:
Program Director Information (Applicant should complete)
Phone Number:
Program Director Signature
I verify that I am an authorized representative of the program indicated above and that the
applicant, ____________________________________, is (or was at the time of graduation)
(print applicant name)
a participant of the program in good standing.
Signature: ____________________________________________________ Date: ______________
_Select Program Name_