Graduate Student Service Center
534 Goodell Building
University of Massachusetts Amherst
Amherst MA 01003-9333
OFF-CAMPUS GENERAL FEE REDUCTION FORM
DEADLINE FOR SUBMISSION: End of the Add/Drop period.
Graduate students completing academic work at an off-campus site may be eligible for a reduction of the Mandatory Fees. Students who
enroll for on-campus course(s), pay the Program Fee or reside in the locations listed below do not qualify for this fee reduction. (NOTE:
Students who file this form are not billed or covered under the Student Basic or Supplemental Health Plans. If you want coverage, please
contact the University Health Services at (413) 577-5000 and inquire about optional enrollment.)
Amherst/North Amherst
Mount Tom
New Salem
Mount Ida Campus
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Name:
Student number:
Department: Semester and year:
Residence during this period:
City State
Reason for Eligibility (check one):
Thesis Independent Study
Dissertation Practicum
Special Topics Internship
Advisor/Committee Chairperson:
Prog
ram Approval:
Graduate Program Director Date
Return completed form to the address above. For questions, please call the Graduate Student Service Center at (413) 545-0722.
