Rev. 01/06/15
Section II – STUDENT Oath and Affirmation
I understand that any material false statement made knowingly and willingly by me on this application, or any
documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a
person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000
or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of
law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from
the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and
complete.
Student Signature Date
Section III –Documentation Requirements
ALL STUDENTS MUST PROVIDE THE FOLLOWING: Completed application, essay, and proof of lawful presence.
LAWFUL PRESENCE IN THE UNITED STATES
In addition to the above waiver-specific documentation requirements, students must be verified to be lawfully
present in the United States before an out-of-state tuition waiver may be awarded.
NOTE: Additional documentation may be requested to determine waiver eligibility.
Submit completed form and required documentation to:
Office of Global Programs
ATTN: Tuition Waiver Officer
Albany State University
2400 Gillionville Road
Albany, GA 31707
Office of Academic Services & Registrar
ATTN: Tuition Classification Officer
Albany State University
2400 Gillionville Road
Albany, GA 31707
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