Peralta Community College District
Student Services
TRANSPORTATION FEE EXEMPTION
Berkeley City College
College of Alameda
Laney College
Merritt College
*Submit the completed form and supporting documentation to the Vice President of Student Services Office.
Student Information
College: Berkeley City College College of Alameda Laney College Merritt College
Name:
Student ID:
Last First M.I.
or las 4 digits of SSN
Address:
No. & Street City State Zip Code
Phone:
Email:
Proposition A, requires that all students enrolled in 6 or more units pay an AC Transit EasyPass fee. California
Education Code, §76361.1(b)(1) authorizes this transportation fee.
Currently, the Peralta Community College District does not have a transportation fee waiver policy for low income
students and all students must pay this fee.
Term: Fall Spring Summer Year 20
Reason for requesting the exemption from the AC Transit EasyPass Fee:
Student is only taking contract education courses.
Student dropped below 6 units on or before the last day to drop with a refund.
Student has a documented medical disability (documentation required).
Student has a disability pass that precludes the student from using the bus (documentation required).
X
Student Signature Date
Vice President of Student Services Use Only
Approved Denied Reason:
X X
VP of Student Services Name (please print clearly) Signature - VP of Student Services Date
District Admissions and Records use only
Approved Denied Reason:
X
Signature Vice Chancellor, Student Services Date
Rev. 11/08/2016
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome