Out-of-State Tuition Waiver Request
Last Name: _________________________________________ First Name ____________________________________
Phone: _________________________________ Email: __________________________________________________
State of Origin: _________________________________ Country of Origin: _________________________________
Admissions Residency Requirements
Submit this form and supporting documentation to the Admissions Office.
Resident of Louisiana one year prior, and
Louisi
ana Driver’s license issued at least one year prior , or
Employed at a location in Louisiana at least one year prior to the semester in question, or
Other substantial evidence that shows the intent to establish and maintain a Louisiana domicile.
DD-214 showing Louisiana residence at the time of entry into the military, and
Proof of current Louisiana residency
Service member in the US Armed Forces *
Dependent of service member of the US Armed Forces *
International students must submit this request EACH semester.
International Qualifications
Resident of Louisiana one year prior, and
Holder of one of the following Visa types
E treaty trader or investor
G representative of an International Organization foreign Information Media Representative
H temporary worker in a “specialty” occupation (H-1 and H-4 may also apply to qualify)
K fiancé, children of U.S. citizen (with proof of marriage to a US citizen)
L intra-company transferee/foreign employer
________ As an international student, I understand this form must be submitted each semester for approval.
Initial
Request for Out-of-State Tuition Waiver
Submit this form and supporting documentation to the Business Office.
Other—(Studen
t must attach a written statement & supporting documentation, if available, explaining the reason for the request.)
Student Signature
Date
Tuition Waiver Approval:
Approved
Denied
Date
STUDENT ID NUMBER
SOCIAL SECURITY NUMBER
OR
Date Processed:
* Use code M
Effective Semester
Bossier Parish Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees, diplomas, and certificates. Contact the
Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Bossier Parish Community College. • Bossier Parish Community
College does not discriminate on the basis of race, color, national origin, gender, age, religion, qualified disability, marital status, veteran's status, or sexual orientation in admission to its programs, services, or
activities, in access to them, in treatment of individuals, or in any aspect of its operations. Bossier Parish Community College does not discriminate in its hiring or employment practices. • Coordinator
for Section 504 and ADA: Angie Cao, Student and Disability Services Specialist - Disability Services, F254, 6220 East Texas Street, Bossier City, LA 71111 - (318) 678-6511 - acao@bpcc.edu. - 8:00 a.m.–4:30 p.m.
M-F, excluding holidays and weekends. • Equity/Compliance Coordinator: Teri Bashara, Director of Human Resources - Human Resources Office, 6220 East Texas Street, Bossier City, LA 71111 - (318) 678-6056
- 8:00 a.m.–4:30 p.m. M-F, excluding holidays and weekends.
Executive Vice-Chancellor
for Business Affairs
or Designee Signature
Revised June 2018
