Admission and Records
Phone: (541) 383-7500
Fax: (541) 318-3700
2600 NW College Way • Bend, Oregon 97703
Please read carefully and fill out this form completely.
Return this form, with a copy of a valid photo ID, including date of birth, to Admissions and
Records: Mail: 2600 NW College Way Bend, OR 97703
Fax: (541) 318-3700
In person at any campus (Bend, Redmond, Madras & Prineville)
COCC Student ID #:
Eligibility (all requirements must be met):
1. Must be an Oregon resident
2. Must be 65 years of age or older at the beginning of the term (see COCC Academic Calendar for dates).
3. A current COCC application, and application fee payment, must be on file. The deadline to submit a new application is
posted on our Academic Calendar at You should apply prior to the start of the term that you wish to take any
4. The tuition waiver is valid for a maximum of 8 credits per term.
5. The tuition waiver is valid only if the class is audited and if space is available (changing to graded will result in tuition/fees
being assessed accordingly).
1. Identify desired classes from the credit class schedule. Continuing Education courses are not covered.
2. No placement test is required for classes taken with the tuition waiver.
3. Attend the class on the first meeting date.
4. Ask the instructor if there is space available in the class. If so, have instructor sign in the appropriate space below.
Note: Students registering before the first day of class will not be eligible to use the waiver.
5. Pay course fees by the second week of the term or at time of registration. Only tuition charges will be waived for
approved classes.
Course Information:
CRN Course Title Grade Instructor Signature Date Signed
(only valid for
2 days)
By signing this authorization, the student acknowledges and accepts the policies as stated above.
Student Signature: Date:
Office Use Only
Photo ID & DOB checked by:
Rev 9/26/19
click to sign
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