STUDENT REPRESENTATIVE FEE
Pe
r Ed Code §76060, this fee supports student representatives who state positions/viewpoints before city,
county, and district governments, and before offices/agencies of city, state, and federal governments. It
was made possible by Assembly Bill 1504.
Exemptions from this fee are provided for religious, political, financial or moral reasons. You may opt
out of this fee during the registration process. If you have already paid the fee and would like a refund,
please visit the Cashier's Office within the first two weeks of school for a refund. No refunds will be
processed after this date.
OPT-OUT FORM
ST
UDENT ID # ___________________________
STUDENT NAME: _______________________________________________
TERM: FALL
SPRING SUMMER
YEAR: ______________
I a
m requesting an exemption of the student representative fee issued to my account for the referenced
term due to:
Religious Reasons
Political Reasons
Financial Reasons
Moral Reasons
SI
GNATURE: _____________________________________________ DATE: ________________
CASHIER OFFICE
FEE AMOUNT WAIVED: $___________ REFUND NEEDED: Y/N
CASH
IER: ____________________________________________ DATE: __________________
BANNER DETAIL CODE: SRFW
Revised 05/19/20 TP
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