Office of Graduate Studies
Application for Full-Time Distant Fee Status
_______________________ _______________________
_______________________ Degree Program: _______________________
_______________
________
As a full-time student my location for the semester will be at a distance of at least 200 km. from Guelph; I am therefore
applying for exemption from the ancillary student fees (except the GSA fees, the Medical Insurance premium, the Dental
Plan premium, and, in the case of international students, the UHIP fee (if applicable) for the semester indicated. I declare
that I will not be on the Guelph campus, other than for Advisory Committee meetings and consulting with Advisors,
during the period below:
NB: A separate form must be submitted for each semester.
___________________
Period of co
mplete absenc
e from cam
pus: ___________
________ ________
___________
Location during ab
sence:
____________________________________________________
____________________ __________________ _____________
This address is:
Postal
Code:Province:City:
Address:
ToFrom
Semester and Year of application: (e.g. Winter 2013)
Department/School:
Student ID:
First Name
:Last Name:
___________Temporary until
_________________________________
_____________ ___________________
DEPARTMENT/SCHOOL:
This is to confirm that the student
is not expecte
d to be present on the Guelph campus during the semester mentioned
above, other than for Advisory Committee meetings and consulting with Advisors.
Advisor Signature: ______________________________________________ ___________________
_________________________________ _______________
____
For OFFICE OF GRADUATE STUDIES use only:
Exemption from student fees granted:
Date:Graduate Coordinator’s Signature:
Date:
Date:Student’s Signature:
Home/Permanent
Yes
______________________________________________ ___________________Date:Signature:
No
Protection of Privacy: We are committed to protecting your privacy. Personal information is collected under the authority of
the University of Guelph Act and pursuant to the Freedom of Information and Protection of Privacy Act (FIPPA). If you have
questions about the use and disclosure of your personal information, call the Office of Graduate Studies at (519) 824-4120
ext. 56833. You can also find more information about access to information and protection of privacy at the University of
Guelph from the University Secretariat.
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