APPLICATION FOR LEGACY ALTERNATE TUITION RATE
Beginning Fall 2011, newly entering freshman or transfer undergraduate students who have parent(s) or legal guardian(s) who are
graduates of Southern Illinois University Carbondale will pay an alternate tuition rate of 0.80 times the applicable in-state or out-of-
state rate for undergraduate students guaranteed for four years.
The application and supporting documents must be filed within 30 school days from the first day of classes during the term for
which you are applying. Late applications cannot be accepted.
STUDENT INFORMATION
Name
Dawg Tag
Date of Birth
Address
City, State, Zip
Email Address
Phone Number
GRADUATE INFORMATION
Name
Name at Graduation (if different than above)
Graduation Month and Year
Degree and Major Awarded
Date of Birth
E-mail Address
Mailing Address (if different than the student
Relationship to Student:
Parent Stepparent Legal Guardian
GRADUATE INFORMATION (IF MORE THAN ONE)
Name
Name at Graduation (if different than above)
Graduation Month and Year
Degree and Major Awarded
Date of Birth
E-mail Address
Mailing Address (if different than the student
Relationship to Student:
Parent Stepparent Legal Guardian
Please submit the following documentation, showing the student's relationship to the graduate:
• Student-Parent Relationship: Student's birth certificate, adoption certificate, or court document(s) linking the student to the parent.
• Student-Stepparent Relationship: Student's birth certificate, adoption certificate, or court document(s) linking the student to the parent.
Marriage certificate or court document(s) the stepparent.
• Student-Legal Guardian Relationship: Court document(s) showing legal guardianship of the student.
For additional information on the Legacy Alternate Tuition Rate, please contact Undergraduate Admissions at admissions@siu.edu or 618-536-4405
FOR OFFICE USE ONLY
Registration Registrar
Legacy Alternate Tuition Rate approved and coded
Documentation Verified Graduation Verified Legacy Alternate Tuition Rate not approved
Documentation not verified Graduation not verified Additional documentation required
Additional documentation required Additional documentation required Term of Entry
Registrar's Office - Mail Code 4701 - Southern Illinois University Carbondale
1263 Lincoln Drive - Carbondale, IL 62901 - 618 453.2963 - Fax: 618 453.2915
