Fillable AB 540 Affidavit California Nonresident Tuition Exemption Application (West Los Angeles College)

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AB 540 Affidavit California Nonresident Tuition Exemption Application (West Los Angeles College)

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AB 540 Affidavit
California Nonresident Tuition Exemption Application
Education Code § 68130.5, as amended, commonly known as AB 540
Please see instructions and general information on the other side.
APPLICATION
I, the undersigned, am applying for the California Nonresident Tuition Exemption at the following college/university,
and I declare the following:
(provide name of college/university above)
1.) Check one box only:
I have a current nonimmigrant visa (not including a T or U visa) as defined by federal law.
Nonimmigrants have been admitted to the U.S. on a temporary visa and include, but are not limited to, foreign students (holding F visas) and exchange visitors (holding J visas)
I have a current nonimmigrant T or U visa as defined by federal law.
I do NOT have a current nonimmigrant visa as defined by federal law.
This includes, among others, U.S. citizens, permanent residents, DACA recipients, and individuals without a current or valid immigration status.
2.) Select all items that apply to you from each column:
Column A
I have 3 years of attendance at a California high
school.
I have 3 or more years of high school coursework
and 3 years of attendance in California elementary
schools, California secondary schools, or a
combination of California elementary schools and
secondary schools.
I attended or attained credits at a combination of
California high school, California adult school, and
California Community College for the equivalent of 3
years or more.*
Column B
I have graduated or will graduate (before the first term of
enrollment at the college/university) with a California high
school diploma or the equivalent (i.e., California-issued
GED, TASC, HiSET or CHSPE).
I completed or will complete (before the first term of
enrollment at the college/university) an associate degree
from a California Community College.
I completed or will complete (before the first term of
enrollment at the college/university) the minimum
requirements at a California Community College for transfer
to a California State University (CSU) or University of
California (UC).
Print Full Name (as it appears on your campus student records) Campus/Student Identification Number
Print Full Mailing Address (Number, Street, City, State, Zip Code) Email Address/Phone Number (Optional)
Signature Date
*A year's equivalence at a California Community College is either a minimum of 24 semester units of credit or 36 quarter units. Only 2 years of full time attendance in credit courses
at the California Community Colleges will count toward the 3 or more years of attendance. Full-time attendance at a California adult school is a minimum of 420 hours of attendance
for each school year.
Please list the schools you attended that would satisfy the requirements under Column A above:
Documentation of applicable school attendance and high school graduation (or its equivalent) is required by the University of California, The California State University and some
California Community Colleges. Follow campus instructions.
AFFIDAVIT:
I hereby declare that, if I am without a lawful immigration status, I have filed an application to legalize my immigration status or will file an
application as soon as I am eligible to do so.
DECLARATION OF TRUE AND ACCURATE INFORMATION:
I, the
undersigned, declare under penalty of perjury under the laws of the State of California that the information I have provided on this
form is true and accurate. I understand that this information will be used to determine my eligibility for the nonresident tuition exemption for
eligible California high school graduates. I further understand that if any of the above information is untrue, I will be liable for payment
of all nonresident charges from which I was exempted and may be subject to disciplinary action by the College or University.
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1. Satisfied either of the following:
a. attended a high school (public or private) in California for three (3) or more years, or
b. attained credits earned in California from a California high school equivalent to three (3) or more years of full-
time high school course work and attended a combination of elementary, middle and/or high schools in
California for a total of three (3) or more years, or a combination of those schools. or
c. attained credits earned at a California adult school, or
d. attained credits at a California Community College, or
e. a combination of the schools listed above.
2. Graduated or will graduate from a California high school, or
a. attained a General Education Development (GED), High School Equivalency Test (HiSET), Test Assessing
Secondary Completion (TASC), or
b. attained an associate degree from a California Community College, or
c. fulfilled the minimum transfer requirements to transfer from a California Community College to a University of
California or California State University, and
3. Will register or enroll in an accredited and qualifying California college or university, and
4. If applicable, complete the affidavit stating that you will legalize your immigration status as soon as you are eligible, and
5. Do not hold a valid non-immigrant visa (A, B, C, D, E, F, J, H, L, etc.) *
*If you have Temporary Protected Status or hold a valid U Visa you are eligible
PROCEDURES FOR REQUESTING EXEMPTION FROM NONRESIDENT TUITION
California Community Colleges
Complete the form entitled California Nonresident Tuition Exemption Request with your college. Submit it to the Admissions
Office at the community college where you are enrolled or intend to enroll. You may be required to submit additional
documentation. Call the college Admissions Office if you have questions.
University of California
The University of California (UC) campuses each have their own nonresident tuition exemption application and affidavit forms.
Requests are not to be submitted until you have been admitted to a UC campus and have filed both a Statement of Intent to
Register and a Statement of Legal Residence. For campus-specific instructions regarding documentation and deadline dates,
contact the campus personnel knowledgeable about AB 540, AB 2000 and SB 68 classifications.
California State University
Complete the form entitled California Nonresident Tuition Exemption Request with your university. Contact the Office of
Admission and Records at the CSU campus where you are enrolled or intend to enroll for instructions on submission, deadline
information, and additional requirements. You will be required to submit final high school transcripts and appropriate records of
high school graduation or the equivalent, if you have not done so already. Call the Office of Admissions and Records at the
campus if you have questions.
AB 540 Affidavit
California Nonresident Tuition Exemption Application
Education Code § 68130.5, as amended, commonly known as AB 540
Instructions Complete and sign this form to request exemption from nonresident tuition charged to nonresident students. If
determined to be eligible, you will receive the exemption for as long as you fulfill the eligibility requirements or until the college or
university no longer offers this exemption. Applying for this exemption does not alter your responsibility to pay, by the campus
deadline, any nonresident tuition and associated fees that may be due before your eligibility is determined.
General Information California Education Code Section 68130.5, exempts any student, other than one with a United
States Citizenship and Immigration Services (USCIS) non-immigrant visa status (*see exception below for students
who have been granted Temporary Protection Status or U visa), who meets all of the following requirements, shall
be exempt from paying nonresident tuition at the California Community Colleges, the University of California, and the
California State University (all public colleges and universities in California).
Eligibility Requirements
The student must have:
10/2018
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AB 540 Affidavit California Nonresident Tuition Exemption Application (West Los Angeles College)

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Completed 25 July 2020

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