An equal opportunity/affirmative action university encouraging diversity.
Office of Admissions
201 Hovey Hall
Campus Box 2200
Normal, IL 61790-2200
Phone: (309) 438-2181
(800) 366-2478
TTY: (309) 438-2006
IllinoisState.edu
Fee Waiver Verification Form
Student Name _________________________________________________________________
Birthdate __________________________________________________________________
High School Students
Student qualifies for the free or reduced-price lunch program.
Yes
No
College Students
Student qualifies for
full federal aid with an estimated family contribution (EFC) of $1000 or less
Student is enrolled in a federal, state, or local program that aids students from low-income
families (e.g., TRiO programs such as Upward Bound)
Certification by sch
ool or college counselor
By signing below,
I verify that the information provided is accurate.
____________________________________________________________________________________
Signature
Print Name
____________________________________________________________________________________
Position
Title
Phone Number
____________________________________________________________________________________
School or College
Date
Please email to
Admissions@IllinoisState.edu or mail this form to:
Office of Admissions
Campus Box 2200
Normal, IL 61790-2200
click to sign
signature
click to edit
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