Please Mail to: 118 College Drive #5171, Hattiesburg, MS 39406 or 601.264.4629
730 East Beach Blvd, Long Beach, MS 39560 or 228.214.3244
or email
Center for Military Veterans, Service Members and Families
Non-Resident Tuition Exception Request Form
Name of Student/Applicant: ID:
Date of Birth: Admit Term: Fall 20 Spring 20 __ Summer20 _ ______
City: State: Zip:
Relationship to Veteran/Service Member (check one):
Self Spouse Son Daughter Step-Son
Step-Daughter Adopted Son Adopted Daughter
Name of Veteran/Service-Member:
Branch of Service: Dates of Service:
Type of Discharge (If Applicable):
Proof of Service and/or Status:
*Veteran/Service Member
Copy of Valid Military ID Card
Copy of Valid Dependent Military ID Card
Copy of DD-214 (member 4 copy)
Copy of Expired Dependent Military ID Card
Copy of Active Duty Orders
Copy of Dependent Birth Certificate or
DEERS Printout
Other Documentation (As Required)
Other Documentation (As Required)
*Veterans/Service Member must provide one of the above listed items as proof of service and/or
*Dependents must provide one item from the Veteran/Service Member list and one item from
the Dependents list.
Attach the documentation to this request no later than the last day to add full-term
classes without permission.
Print and sign the form and return it as directed below.
Student: Date
Veteran/Service Member: Date
Office Use Only:
Active Duty Veteran
Approved Date
Not Approved Date