o Student has received or is eligible to receive an ACT or SAT testing fee waiver or received an application fee waiver.
o Student has received or is eligible for the Federal Pell Grant.
o Student is enrolled in or eligible to participate in the Federal Free or Reduced Price Lunch program (FRPL).
o Student’s annual family income falls within the income Eligibility Guidelines* set by the USDA Food and Nutrition Service.
o Student is enrolled in a federal, state or local program that aids students from low-income families (e.g.,TRIO programs such as
Upward Bound).
o Student’s family receives public assistance.
o Student lives in federally subsidized public housing, a foster home, or is homeless.
o Student is a ward of the state or an orphan.
o Other request from high school principal, high school counselor, financial aid officer, community advisor/leader or other official
who can attest to the student’s circumstances.
o Given my knowledge of this student’s family circumstances and after reviewing the eligibility guidelines, I believe that providing
the application fee would present a hardship. Explanation:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Request for Enrollment
Deposit Fee Waiver
SEND THIS FORM DIRECTLY TO THE POSTSECONDARY
INSTITUTION/ORGANIZATION
STUDENT: Print or type the information requested below. You must personally sign the Certification Statement.
AUTHORIZED OFFICIAL: Print or type the information requested below and check the indicator(s) of economic need.
You must personally sign the Certification Statement.
TO: DEAN/DIRECTOR OF ADMISSION AT:
_______________________________________________________________________________________________________
NAME OF COLLEGE OR UNIVERSITY
CERTIFICATION STATEMENT: I certify that I understand and meet all eligibility requirements to request an enrollment deposit fee waiver.
_______________________________________________________________________________________________________
STUDENT’S NAME STUDENT’S SIGNATURE
_______________________________________________________________________________________________________
STUDENT’S ADDRESS CITY STATE ZIP
CERTIFICATION STATEMENT: I certify that the student named on this form has been granted admission to a postsecondary institution
AND meets the indicator(s) of economic need checked below.
_______________________________________________________________________________________________________
AUTHORIZED OFFICIAL’S NAME AUTHORIZED OFFICIAL’S SIGNATURE
_______________________________________________________________________________________________________
AUTHORIZED OFFICIAL’S TITLE AUTHORIZED OFFICIAL’S EMAIL
_______________________________________________________________________________________________________
NAME OF SECONDARY EDUCATIONAL INSTITUTION OR ORGANIZATION CEEB# OR PROGRAM#
_______________________________________________________________________________________________________
ADDRESS PHONE
ECONOMIC NEED: The student must meet at least one of the following indicators of economic need. If no item is checked, the
request will be denied. (If applicable, institutions should also contact their financial aid offices for the student’s FAFSA application.)
*To view USDA Income Eligibility Guidelines for the Free or Reduced Price Lunch Program or review FAQs related to this form visit http://bit.ly/NACACfeewaiver.
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