Revised F
ebruary 26, 2020
CALIFORNIA NONRESIDENT TUITION EXEMPTION REQUEST
(Education Code section 68130.5, commonly known as AB 540
Effective Jan. 1, 2018)
INSTRUCTIONS
Complete and sign this form to request exemption from nonresident tuition charged to nonresident students.
Once determined to be eligible, you will continue to receive the exemption as long as you fulfill 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.
APPLICATION
Name___________________________ College St
udent ID: ____________________________
I, the undersigned, am applying for the California Nonresident Tuition Exemption at (specify the College)
and declare that the following apply to me. __________________________
1.) Check one box only:
I have a current nonimmigrant visa (not including a T and 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 current or valid
immigration status.
2.) Select all items that apply to you from each column (must satisfy at least one from each column to be
eligible):
Column A
Column B
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 and secondary schools.
I attended or attained credits at a combination
of California high school, California adult
school, and/or California Community College
for the equivalent of (3) years or more.*
I have graduated or will graduate (before the
first term of enrollment at the CCC) with a
Californ
ia high school diploma or the
equivalent (i.e., California-issued GED, CHSPE).
I completed or will complete (before the first
term of enrollment at the CCC) an ass
ociate’s
degree from a California Community College.
I completed or will complete (before the first
term of enrollment at the CCC) the m
inimum
requirements at a California Community
College for transfer to the California State
University.
*A year’s eq
uivalence at a California Community College is either a minimum of 24 semester units of credit or 36
quarter units. Only two (2) years of full-time attendance in credit courses at a California Community College will count
toward the three (3) or more years of attendance. For noncredit courses, a year’s attendance is a minimum of 420 class
hours per year (a semester is equivalent to a minimum of 210 hours and a quarter is equivalent to a minimum of 140
hours). Full-time attendance at a California adult school is a minimum of 420 hours of attendance for each school year.
Please provide information on the schools you attended and referenced above, including the dates you
attended and the number of credits or hours obtained:
Name of CA School
Type of School
(high school, adult
school or community
college)
City
From
(Month/Year)
To
(Month/Year)
Number of
Credits
or
Hours
Applicants must submit, as part of this form, official transcripts/attendance records that validate any of the
information above as requested by the College, District, or University residence official.
AFFIDAVIT:
By signing this document below, I hereby state that if I am a non-citizen without a current or valid 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 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 California
Nonresident Tuition Exemption. I further understand that if any of the above information is found to be false, I
will be liable for payment of all nonresident tuition charges from which I was exempted and may be subject to
disciplinary action by the College or University.
FULL NAME CAMPUS ID NUMBER EMAIL ADDRESS
SIGNATURE DATE
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