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SENIOR CITIZEN TUITION WAIVER FOR AUDIT/CREDIT
Please review all instructions on the reverse side of this form. Complete this form, attach any
required documentation, and submit to the Admissions and Advising Center (M144). Approvals will
be granted after the LAST DAY TO REGISTER/ADD A COURSE OR REQUEST AN AUDIT ADD/DROP.
The applicant will be notified by the academic division of the final decision. APPLICANTS MAY
ATTEND CLASS ONLY AFTER BEING NOTIFIED BY THE ACADEMIC DIVISION.
Student Name: __________________________________________ Student ID Number: _________________________
(Please Print Clearly)
Student email address or *phone number (for notification the week following the add period): __________________________
Course Title: _________________________ Catalog Number: _____________ Course Number: ________________
(example: MUS) (example: 137) (example: 45525)
Select one: □ I will take this class for CREDIT. (Student must prove income does not exceed $23,850 by attaching most
recent Virginia income tax return)
□ I will AUDIT this class. (No grade earned, no income provision)
To be eligible for free tuition for courses for CREDIT or AUDIT, I certify that:
• I have been domiciled in Virginia for at least one year prior to the first day of the term of enrollment.
• I have applied and have been admitted to the College.
• I am, as of this day, 60 years of age or older. My birth date is ________________________. (Proof of age must be provided.)
• I have been domiciled in Virginia for at least one year prior to the first day of the term of enrollment.
I hereby certify that I am qualified for free tuition for courses under the Senior Citizens’ Higher Education Act of 1974 for this academic
year. I understand that fee-paying students must be accommodated first according to state law, and that I may be dropped from my class
should another fee-paying student wish to enroll in it. I understand that I do not enroll myself in the class and I do not attend the class nor
have access to Canvas until the registrar completes enrollment AFTER the last day to add. As a senior citizen, I may choose to register
and pay for a class to guarantee a seat; however, I may not subsequently change to tuition-free status for that semester.
Student Signature: _________________________________________Date:_______________
Approved Not Approved Dean’s Initial & Date:
