Questions? Contact Manhattan Tech at 785-587-2800, Monday-Thursday, between 7:30 a.m. and 5:30 p.m. or Friday 7:30 a.m. and 5:00 p.m.
Verification (Option 1 or Option 2 required)
Student Confirmation (All fields are required) (Complete only top if current student)
U.S. Social Security Number: _____________________________ Email Address:_________________________________
Name: ___________________________ / ____________________________ / _____________________________
Last First Middle
Address: ________________________________________________ __________________________
Street/P.O. Box Apt #
_______________________________ ____________________ ______________________________
City State/Province Zip/Postal Code
Phone Number
(Including Area Code): _______________________________________ Date of Birth: _____________________________________
Household size (including student): ________ Total annual household income before taxes (all sources): _____________________
My signature confirms that:
I meet the annual income criteria above and am requesting an application fee waiver.
I attached the applicable documentation in support of this fee waiver (Refer to option 1 or 2 below).
Signature of Student: ___________________________________________________ Date: _______________________________
Signature of Head of Household: _______________________________________________________________________________
Option 1: Advisor Certification
To the best of my knowledge, the student meets the requirements outlined on this fee waiver form. The student is aware that financial
documentation in support of this fee waiver may be requested.
Advisor Signature: ________________________________ Date: _______________________
Print Name of Advisor:
____________________________________________________________________________
Option 2: Proof of Income
Students who are unable to obtain an advisor signature, must provide proof of income and attach a copy to this form. Proof of
income may include any one of the following:
Most recent federal tax return
Statement of Social Services benefits
Student Aid Report (SAR) from the FAFSA
Proof of unemployment insurance benefits
Household
Size:
Annual
Income
1
$12,706
2
$17,240
3
$21,720
4
$26,200
5
$30,680
6
$35,160
7
$39,640
8
$44,120*
*Plus $4,480 for each
family member in
excess of eight
To be considered for an application fee waiver from Manhattan Area Technical College, students must:
Complete and submit the Fee Waiver Request Form (this form) with required signatures. Other
acceptable fee waiver forms include an ACT or SAT fee waiver (not registration card) or other
official form from a recognized community agency such as the MHK Workforce Center at the
Central Kansas Educational Opportunity Center or a recognized TRIO program.
Be a resident of Kansas or a citizen of the United States.
Meet the financial eligibility criteria shown in the table to the right
If eligibility is confirmed, the Admissions Office will grant an application fee waiver for the selected
applicant.
Application Fee Waiver Request
Revised 2/5/2020
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