Revised: 11/30/2017
AB343 Nonresident Tuition Exemption Request
Please complete the form below to request exemption to nonresident tuition pursuant to California Education
Code 68075.6. A student of the California Community Colleges who has a special immigrant visa that has been
granted a status under Section 1244 of Public Law 110-181 or under Public Law 109-163, or is a refugee admitted
to the United States under Section 1157 of Title 8 of the United States Code, and who, upon entering the United
States, settled in California, shall be exempt from paying the nonresident tuition fee required by Section 76140 for
the length of time he or she lives in this state up to the minimum time necessary to become a resident.
I am requesting the AB343 Nonresident Tuition Exemption for those with an eligible immigration status and
declare the following:
My current immigration status/Visa type is (check one and attach appropriate documentation):
Special Immigrant Visa (e.g.- SI1, SI2, SI3, SQ1, SQ2, SQ3)
My present stay in California began on: _______________________________________
I 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 this information will be used to determine my eligibility for the
nonresident tuition exemption for those with an eligible immigration status. 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 granted
exemption to and may be subject to disciplinary action by the College.
I also understand this exemption expires one year after I began residing in California after which I may be
required to provide documentation to reclassify my residency for tuition purposes or pay nonresident tuition.
The last semester of eligibility will be identified by staff, for your information, at the bottom of this form.
Staff Use Only:
Eligible: _________ Last Eligible Term: _______________
(Student will be considered nonresident for tuition purposes after this term)
Processing Information
Term Updated: _______________________ Residency Panel Added For: _____________________
All Los Rios Colleges Updated: _________________
Staff Initial and Date: _______________________________________________
Print Full Name (as it appears on your records)
Student ID Number
Print Full Mailing Address (Number, Street, City, State, Zip Code)
Phone Number
Student Signature