Fillable Request For Fee Waiver - Request for Admission Application Fee Waiver

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Request For Fee Waiver - Request for Admission Application Fee Waiver

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X:\Admissions\Forms\2017‐18\request_for_fee_waiverOnbase:ADUGApplicationwithstatus:waiverRevised9/18/17

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Request for Admission Application Fee Waiver

UAAofferstheopportunityforhighschoolstudentstoapplyforanapplicationfeewaiverwhenthefeepresentsa

financialhardship.Thestudent’ssecondaryschoolcounselormustverifythestudent’seligibility.

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I.STUDENTINFORMAT IO N

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__________ __________ _____________________________________________________________

LastNameFirstNameM.I.DateofBirth



II.ECONOMICNEEDINDICATO RS :

studentsmustmeetoneofthefollowingindicatorsofeconomicneed.

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III.FORCOMPLETIONBYCOUNSELOR

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__________ __________ __________ __ __________ __ __________ __ __________ __________ __ __________ __ ___

HighSchoolName

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__________ __________ __________ __ __________ __ __________ __ __________ __________ __ __________ __ ___

SchoolCounselor’sName

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__________ __________ __________ __ __________ __ __________ __ __________ __________ __ __________ __ ___

CounselorContactPhoneand/orE‐mailAddress

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Icertifythatthestudentnamedonthisformiscurrentlyenrolledatthisschoolandmeetstheeconomic

indicator(s)checkedabove.

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________________________________________________________________

SchoolCounselor’sSignatureDate

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SubmitthisformdirectlytotheUAAOfficeofAdmissions:

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ByEmail: ByFax: ByMail: InPerson:

admissions@uaa.alaska.edu (907)786‐4888 3211ProvidenceDrive,UC106

Anchorage,AK99508‐4614

3901OldSewardHwy

Anchorage,Alaska99503

StudentqualifiesforACTorSATtestingfeewaiver.

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StudentqualifiesfortheFederalFreeorRedu cedLunchprogram.

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Studentisawardofthestateorhomeless.

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Other:

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