Request for an Application Fee Waiver
Admission Application Fee $30
International Student Application Fee $50
Bachelor’s Application Fee $25
Important Notes:
BSN Program Application Fee is not eligible for fee waiver.
Student must be enrolled and maintain the enrollment status during the term in which the application fee is incurred.
STUDENT: Print or type the information requested below.
CERTIFICATION STATEMENT: I certify that I meet one of the eligibility requirements to request a waiver for the application fee.
STUDENT’S NAME STUDENT’S SIGNATURE MDID #
MDC EMAIL ADDRESS TELEPHONE NUMBER
STUDENT DEAN OR DESIGNEE: Print or type the information requested and check one or more of the eligibility requirements.
Student Dean or designee must personally sign the Certification Statement below.
CERTIFICATION STATEMENT: I certify that the student named on this form meets
the eligibility requirement(s) checked below.
NAME SIGNATURE
TITLE CAMPUS
ELIGIBILITY REQUIREMENTS: Student must meet at least one of the following eligibility requirements to qualify for an
application fee waiver. Supporting documentation must be provided.
Student is a U.S. Veteran or active duty military.
Student is seeking admission as a Dual Enrollment/Early Admission Student.
Student or family is receiving public assistance (Department of Children and Families (DCF) form is required).
Student is living in federally subsidized public housing, a foster home or experiencing homelessness.
Student is a ward of the state or an orphan.
Comments:_______________________________________________________________________________________
________________________________________________________________________________________________
_________________________________________________________________________________________________
Revised: 3/6/18
Last Revision Date: 8/2/19
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