Fillable I hereby request exemption from the payment of (Merced College)

Fill Online, Printable, Fillable, Blank I hereby request exemption from the payment of (Merced College) Form

Use Fill to complete blank online MERCED COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

I hereby request exemption from the payment of (Merced College)

On average this form takes 3 minutes to complete

The I hereby request exemption from the payment of (Merced College) form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Merced College

BROWSE MERCED COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
OFFICIAL MERCED COMMUNITY COLLEGE DISTRICT FORM
STUDENT HEALTH FEE EXEMPTION
STUDENT FEES/#2201/NOVEMBER 2017
I hereby request exemption from the payment of any fee for the use of the Student Health Center or other health
services. I am an adherent of the teachings of a religious sect, denomination, or organization, and in accord with its
teachings depend exclusively upon prayer for healings. Therefore, I request exemption from the payment of the
fee for health supervision and services provided in accordance with Section 76355 (c) of the Education Code
Section (c) (1), which reads as follows:
(c) The governing board of a district maintaining a community college shall adopt rules and regulations
that exempt the following students from any fee required pursuant to subdivision (a):
(1) Students who depend exclusively upon prayer for healing in accordance with the teachings of a bona fide
religious sect, denomination, or organization.
____________________________________________________
Name (Printed)
Student ID #: ___________________Term:________________
This form must be submitted to the Student Fees Office by the end of the first week of the term in order to decline this fee.
This form can be faxed to (209) 381-6566 or submitted at the Student Fees Office.
OFFICE USE ONLY
Term: ________________ Date Received: ________________ Staff Initials: ______________ Date Processed: ________________ Staff Initials: _________
____________________________________________
Signature
Date: _______________________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

I hereby request exemption from the payment of (Merced College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 September 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document