10/19
REQUEST FOR DEFERRAL
OF APPLICATION FEE
FOR ADMISSION
THE EASTERN EDGE
Student name (please print) Date of birth
Address City State Zip code
Email Telephone Start term
HIGH SCHOOL SENIOR APPLICANTS
Student: Give this form to your high school counselor or other school ocial for completion.
Counselor or other designated school ocial: I recommend an admission application fee deferral for the student named above. I base my
recommendation on the following criteria (check all that apply):
q Student participates in or is eligible for a free or reduced lunch program.
q Student participates in or is eligible for a TRIO - type college preparatory program such as Upward Bound, Talent Search, EOP, HEP, etc.
q Student is a recipient of student assistance or U.S. Public Assistance.
q Student is eligible for College Board or NACAC fee waiver.
Name of counselor/agency ocial (please print)
Name of school/agency
Email
Signature of school/agency ocial
TRANSFER OR POST-HIGH SCHOOL APPLICANTS
Please check all that apply. You must supply documentation as indicated.
q I am a current participant in an Equal Opportunity Program (EOP), TRIO, or other similar program at the college or university I am
currently attending. Documentation required: Signed and dated statement from the institution’s program director, including director’s
name, signature, title, and phone number.
q My FAFSA Expected Family Contribution (EFC) is: less than $5,500. Documentation required: Copy of part one of the FAFSA Student
Aid Report (SAR) from the institution you are currently attending.
q I am a current recipient of U.S. Public Assistance (food stamps, cash, and/or medical assistance) or public assistance from my state.
Documentation Required: Signed and dated statement from your caseworker or a copy of your SNAP card.
q I am currently classified as a dislocated worker. Documentation required: Copy of Determination of Dislocated Worker Form 1992B or
other approved documentation.
q I have authorization and certification of entrance or re-entrance into rehabilitation. Documentation required: Federal form the U.S.
Department of Veterans Aairs.
Name of college/university now attending (if applicable)
STUDENT AUTHORIZATION
I request that Eastern Oregon University defers my admission application fee. I understand that deferral means I do not need to pay the fee
now, but I will be required to pay the fee when I enroll.
Student Signature Date
Return completed form and supporting documents to Eastern Oregon University
Oce of Admissions, Inlow Hall 115, One University Blvd., La Grande Ore. 97850
Email: admissions@eou.edu
Fax: 541.962.3418
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