Fillable Certification For Tuition Waiver Form (Montgomery College)

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Certification For Tuition Waiver Form (Montgomery College)

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Certification for Tuition Waiver Form
Student Name
Student ID M-
Name of Social Security/Federal Official
Student Signature Date
ES 01/16/19
Phone
I certify that the above student is out of the workforce as a result of permanent disability and is receiving a social security
disability benefit (SSDI) or supplemental security income (SSI) as defined by the Social Security Act, Railroad Retirement Act, or
in the case of a former federal employee, from the federal retirement or pension authority (U.S. Office of Personnel
Management).
Individuals receiving SSI or SSDI benefits as a dependent or survivor of a disabled beneficiary do not qualify for this waiver.
Office Use Only (Initial/Date)
Affix official address stamp of Social Security Office or Federal Agency here:
Signature Date
Social Security Number (required)
Social Security Administration, Railroad Retirement Board, or U.S. Office of Personnel Management Official:
Major/Curriculum Title Curriculum Code
By signing this form, I authorize the Social Security Administration, Railroad Retirement Board, or U.S. Office of Personnel
Management (as applicable) to release information about me; I acknowledge that this form is valid for one academic year and
must be renewed each academic year; I acknowledge that I must apply for financial aid by the priority deadline; and
I
acknowledge that I will be responsible for charges incurred through registration if I do not qualify for the
disability tuition waiver.
Major updated (if applicable)
SSN on file
NO Hold
Disability Waiver
Ask when submitted FAFSA
Please see page 2 of this form for very important instructions about eligibility and limitations.
-If you drop a class before the end of the third week of the semester for fall or spring classes, or before the end of the first week of classes for
winter or summer classes, it will not be included in the Disability Tuition Waiver. You will owe the tuition and the fees for that class.
-In accordance with the Maryland General Assembly guideline, Montgomery College will discontinue the tuition waiver if you enroll in a course
with less than 10 regularly enrolled students.
See eligibility requirements on the reverse side. For more information, visit www.montgomerycollege.edu/hb104. Bring
this form to a Social Security Administration Branch, the Railroad Retirement Board, or the U.S. Office of Personnel
Management, as appropriate, for signature and stamp. Return completed form to the Office of Enrollment Services by
the end of the third week of classes for fall and spring semesters, and by the end of the first week of classes for winter
and summer terms. Only one form per academic year needs to be submitted.
This form is valid for the current academic year, which begins in fall and ends at the conclusion of summer II.
Term/Year
When did you submit your FAFSA for this academic year? Indicate month and year:
Priority deadlines are: March 1 for fall, November 1 for winter and spring, April 1 for summer
Note: If you did not submit your FAFSA by the priority deadline for the first semester in the academic year that you wish to register,
you will not qualify for the disability tuition waiver for that particular semester.
If you need to update your major, please fill out a Declaration or Change of Program of Study Form and submit to the Office of
Enrollment Services.
Fall Winter Spring
Summer I
Summer II
HB 104 (http://mlis.state.md.us/2011rs/chapters_noln/Ch_576_hb0104T.pdf), enacted by the 2011 Maryland General Assembly,
redefines the tuition waiver for students with disabilities as those out of the workforce by reason of total and permanent disability
and entering community colleges. HB 104 supersedes previous legislation and proposes significant changes to Section 16-106c
of the Education Article, Annotated Code of Maryland.
Eligibility:
1. Any resident of Maryland who is out of the workforce because of a permanent disability as defined by the Social Security Act,
the Railroad Retirement Act, or in the case of former federal employees, the Office of Personnel Management, and enrolls in a
community college class that has at least 10 regularly enrolled students, may be eligible for a tuition waiver.
2. The waiver is available for enrolling in up to 6 credits per semester without declaring a degree or certificate program. Any
further credits, up to 12 credits per semester, will require you to enroll in a degree program, or a certificate program that leads to
employment. Letter of Recognition and non-credit courses are not eligible for the waiver. *This waiver does not cover
courses taken for audit.
3. You are required to apply for financial aid and submit your FAFSA by the priority deadline to receive this waiver (additional
information is below.)
4. Individuals receiving SSI or SSDI benefits as a dependent or survivor of a disabled beneficiary do not qualify for this waiver.
The Student Will:
1. Complete the Free Application for Federal Student Aid at www.fafsa.gov and submit it to the Office of Financial Aid by March 1
for fall courses, November 1 for spring courses, or April 1 for summer courses.
2. Obtain a Certification for Tuition Waiver form from www.montgomerycollege.edu/studentforms.
3. Take the form to the Social Security Administration office that serves your area, or, if appropriate, to the Railroad Retirement
Board or the federal agency from which you retired due to disability to have your form signed and certified that you are receiving
SSI or SSDI payments and are permanently disabled.
4. Return the completed Certification for Tuition Waiver form to the Office of Enrollment Services by the end of the third week of
the fall or spring semester, or by the end of the first week of the summer or winter term. Your form should include a major/
curriculum title and curriculum code for a degree program or a certificate program if you plan to enroll in more than 6 credits per
semester.
5. Register for credit classes.
Adjustments to your account will be made approximately halfway through the semester or term in which you
are registered or after your financial aid is awarded if you are a late applicant.
Limitations:
- If you did not submit your FAFSA by the priority deadline for the first semester in the academic year that you wish to
register, you will not qualify for the disability tuition waiver for that particular semester.
- The tuition waiver does not apply to fees.
- You may have up to 12 credit hours covered by the waiver each semester. (The waiver is available for enrolling up to 6 credits
per semester without declaring a degree or certificate program. Any further credits, up to 12 credits per semester, will require you
to enroll in a degree program, or a certificate program that leads to employment. Letter of Recognition is not eligible for the
waiver.) *This waiver does not cover courses taken for audit.
- If you drop a class before the end of the third week of the semester, or before the end of the first week of either summer
session, it will not be included in the Disability Tuition Waiver. You will owe the tuition and fees for that class.
- In accordance with the Maryland General Assembly guideline, Montgomery College will discontinue the tuition waiver if you
enroll in a course with less than 10 regularly enrolled students.
- This process applies to Maryland residents. Students who reside out of state will not qualify for the disability tuition waiver.
Guide for Tuition Waiver for Students with Disabilities
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Certification For Tuition Waiver Form (Montgomery College)

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Completed 20 July 2020

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