Term: Fall 20____ Spring 20____ Su
OPTION C – Exemption of No n-Resident Surcharge
Your answer to ONE of the following criteria must be yes to qualify under option C, and all documentation will be
required when this form is submitted. A student does NOT need to complete this form to enroll in up to four
credit hours within the UA system during a semester at the resident tuition rate.
Note: If you a re a beneficiary on a University of Alaska College Savings Plan account and have been for t he past
two years you may be entitled to a waiver of the non-resident surcharge up to t he amount o f t uition be ing pa id for
by your college savings plan account. To determine your eligibility and request a waiver, call the UA College
Savings Plan office at (907) 474-5671; you do n ot need to submit this form.
I am eligible for resident tuition a ssessment because I am:
United States personnel on active duty, their spouse, or dependent child.
A United States veteran eligible for a Veterans Administration education benefit or the spouse or dependent child of said
veteran. Qualifying students must move to and remain domiciled in the state of Alaska during their course of study.
A member of the National Guard, their spouse, or dependent child.
A dependent child of a person who graduated and holds an Associate, Bachelor’s, Master’s or Doctor’s degree from the
University of Alaska. Dependency must be demonstrated by the most current federal income tax return that has been filed
within the past 16 months.
Year Graduated from University of Alaska: __________________
Parent Name at Time of Graduation:______________________________________ Date of birth:___________________
(First, Middle, Last)
A dependent child of an Alaska resident as evidenced by the most current federal income tax return that has been filed
within the past 16 months.
A student participating in the Western Interstate Commission on Higher Education (WICHE) Western Regional Graduate
Program (WRGP).
A student from other states or provinces whose public universities waive nonresident tuition surcharges for Alaska residents
as listed in UA Regulation 05.10.050.
City Name:__________________________________
(City Name and Country)
A student from a foreign city or province that has established sister city or sister province relationships with the state of
Alaska, or Alaska municipalities, and that have been approved by the president as listed in UA Regulation 05.10.050.
City Name:__________________________________
(City Name and Country)
A current UA Scholar designated by the UA Scholars Program.
The spouse or dependent child under the age of 24 of a University of Alaska employee in a benefit-eligible position.
Employee Name:_______________________________________ Employee ID:______________________
(First, Middle, Last)
A student that graduated within the past twelve months from a qualified Alaska high school.
To be considered a qualified high school for the purposes of UA residency tuition assessment, a high school must be located
in the State of Alaska, issue a diploma recognized by the Alaska Department of Education and:
• be a public high school listed in the current State of Alaska Department of Education directory; or
• be accredited by the Northwest Association of Accredited Schools; or
• be a private school properly registered with the State of Alaska Department of Education.
I am a United States citizen or eligible non-citizen and I am declaring my intention to remain in Alaska indefinitely. I certify that I am or will
be an Alaskan resident for tuition purposes as defined above and will file an application for resident tuition with the appropriate UAA, UAF,
or UAS admissions office prior to the published end of the add/drop period for regular semester-length courses time period of instruction for
the semester for which residency is sought. My failure to file by this date will waive any claim for resident tuition assessment in that
semester or prior semesters unless otherwise determined by the chief enroll
ment officer. Applicants with prior documented Alaska
residency will be granted a 60-day extension to the above stated deadline to prove re-establishment of their residency.
Signed:
X Date:
OFFICE USE ONLY:
mmer 20____
Residency approved b y Date:
Residency denied by Date:
July 9, 2010
