MILITARY REQUEST FOR
WAIVER OR NONRESIDENT FEES OR RECLASSIFICATION
Chabot ID#:
Student Name:
Active members of the military and their dependents who are domiciled or stationed in California on active
duty, veterans who were stationed in California on active duty for more than one year immediately prior to
being discharged no longer than two years ago, and “covered individuals” under VACA Section 702 are
exempt from nonresident tuition for the duration of their enrollment at a community college.
Reference: ECS 68074, 68075, 68075.5; T5 54041, 54042
Please complete the following questionnaire:
State of Entry:
Permanent Duty Station:
State of Domicile:
“Home of Record” on DD 214:
Are you still an active member of the armed forces? Yes No
Station Location and Dates:
If applicable, date separated from active duty: / /
I will be using Post-9/11 GI Bill or Montgomery GI Bill Active Duty benefits: Yes No
If you are an active service member stationed or domiciled in California on active duty, submit the
following documentation:
1) Statement from your commanding or personnel officer listing the dates and location of assignment.
If you are a veteran who was stationed in California on active duty for more than one year immediately
prior to being discharged no longer than two years ago, submit the following documentation:
1) Your DD Form 214.
2) Your military orders listing dates and location of assignment in California.
If you are a “covered individual” under VACA Section 702, submit the following documentation:
1) Your DD Form 214.
2) Certificate of Eligibility showing you are eligible for Post-9/11 GI Bill or Montgomery GI Bill Active Duty benefits.
By signing this form you understand that any misrepresentation of information provided may result in disciplinary action in
accordance with Student Disciplinary Action and/or a financial obligation that must be paid in accordance with the
processing and collection of tuition and fee payments. Further, you understand that state residency changes will not be
made retroactively and that the deadline to make a residence change is prior to the start of the enrolled term.
Signature: Date:
You will receive notice of our decision by email in approximately
7 business days following receipt of your request.
OFFICE USE ONLY
Nonresident waiver CA Reclass Out of State Resident
Eff. Term: _______ Eff. Date: ________ Banner amended: _____ Initials:____ SGASTDN: ___ Student Notified :___
NA 6/2015
