OFFICIAL MERCED COMMUNITY COLLEGE DISTRICT FORM
STUDENT REPRESENTATION FEE WAIVER FORM
STUDENT FEES/#2153/MAY 2020
ROUTING PROCEDURE: INITIATOR>STUDENT FEES>
I hereby refuse to pay the Student Representation Fee in adherence with Section 76060.5 of the Education Code of
the State of California.
_____________________________________________
Signature
_________________________________________________
Name (Printed)
Student ID #: _________________Term:________________
Date: ________________________________________
This form must be submitted to the Student Fees Office by the end of the first week of the term in order to
decline this fee. This form may be submitted by fax to (209) 381-6566, email at studentfees_custsvc@mccd.edu,
or in person at the Student Fees Office.
Office Use Only: Term: _________ Date Received: ____________ Staff Initials: ________Date Processed: _________ Staff Initials: _______
