REQUEST FOR APPLICATION FEE WAIVER
APPLICANT INFORMATION:
Student Name:
Date of Birth:
Mailing Address:
Telephone:
City, State, ZIP:
Email Address:
I CERTIFY THAT I HAVE MET THE FOLLOWING REQUIRED CONDITIONS:
(Please note that all of the below conditions are required.)
I have attached an explanation of how I intend to pay for my education at COCC.
I have submitted my FAFSA to COCC at least one week ago and it indicates I have
an Expected Family Contribution of 0.
I have attached a letter from a local social service agency, or from the Secretary,
Higher Education of the CTWS Tribal Higher Education Department verifying
that I receive assistance from them and am unable to pay for the application fee.
I have attached my admissions application and understand that if this request is denied,
I will be responsible for the non-refundable application fee at that time.
POLICY REMINDER:
By signing this authorization, the applicant acknowledges that a waiver of the application
fee is not guaranteed and will only be considered if all the above required conditions are
met. The decision on this request is final and not eligible for appeal or for the student
petition process.
Applicant Signature: Date:
This form must be submitted with your admissions application either in person to Enrollment Services at any
COCC Campus, or via fax (541-318-3700) or via email (welcome@cocc.edu).
OFFICE USE ONLY
Approved | Not Approved (circle one) By:
Date:
Reason (if not approved):
Instructions: Attach this waiver request and all included documents to application for admissions. Verify 0 EFC in ROARMAN, no
printout necessary. Budget statement needs to be included for consideration. If not approved, student must pay application fee prior
to processing of application. If they cannot pay at that time, the application must be returned to them at that time. If approved, enter
APW code into SPACMNT with description App Fee Waiver Request Approved. If not approved, enter GE code into SPACMNT
with description reason for denial.
01/16
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