HIGH SCHOOL VERIFICATION (OUT OF STATE) WAIVER
I, the undersigned, acknowledge the following:
My waiver of tuition will only be applied to eligible fees; I understand a portion may still be owed.
Signature (Student)
FOR PALM BEACH STATE COLLEGE INTERNAL USE ONLY
Palm Beach State College shall waive allowable out of state tuition for each recipient who is eligible where:
(a) Student has provided documentation to the Registrar’s Office meeting eligible criteria:
i) Attended a Florida High School (private or public) for 3 consecutive years before graduating from a Florida High School.
ii) Submitted an admission application to a Florida College System Higher Education Institution within 24 months of high
school graduation.
(b) Eligibility documentation may not need to be verified for subsequent terms; however, a form will need to be submitted each
term for waiver authorization.
(c) Student does NOT have 3
rd
attempt courses waived.
(d) Student has NOT received more than 110% of their program courses waived.
Last Name:
Student ID:
First Name:
Fall
I am requesting a waiver for:
Spring Summer
Name of Courses: List the course number and reference number
Course ID Reference Number
Date
Signature (Registration Rep.)
Date
MI:
Registrar's Office:
Verified (FSS 1009.26):
Cashier's Office:
Customer Number: 2318 OUT OF STATE HIGH SCHOOL VERIFICATION
NoYes
Registration Rep. Name (Printed)
Year
Contract:
Receipt Number:
Print Form
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