TO BE COMPLETED BY ALL APPLICANTS AND SIGNED BY A NOTARY PUBLIC
I understand that this fee classification review is for the _______________ semester only, and that I must personally initiate review action for each subsequent
semester of re-enrollment as a part-time student. I further agree that if I cease full-time employment or register as a full-time student, I will so notify the university
and be responsible for payment of out-of-state fees for the above semester. With this in mind, I certify that the above statements are correct and complete.
Date:_________________________________________________ Signature: ______________________________________________________________________
State of _______________________________________________ County of_______________________________________________________________________
Subscribed and sworn before me this________________________ day of ________________________________________________________________ 20_______
Notary Public___________________________________________ My commission expires ___________________________________________________________
School of Graduate Studies
Box 70720
Johnson City, TN 37614-1710
(423) 439-4221 phone or (423) 439-5624 fax
Statement in Support of Application for Fee Classification for Part-Time Students
PLEASE ANSWER ALL QUESTIONS, INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED
1. Classification :
(Check One ) Degree Seeking_______ Non-Degree Seeking_______
2. Student ID:______________________________________________ Date____________________
3. Name:_________________________________________________________________________________________________________________________
Last First M iddle
4. Local Address:__________________________________________________________________________________________________________________
Street Address
__________________________________________________________________________________________________________________
City State ZIP
5. Local Telephone:____________________________________________ E-Mail________________________________________________________
6. Permanent Home Address:_________________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________________________
City State ZIP
7. If you have attended ETSU, state period of attendance. _____________________________________ to ________________________________________
8.
Indicate your full-time employment in Tennessee and give name of employer, the location and dates of employment. (Graduate Assistantships and
Research Assistantships are not considered full-time positions.)
___________________________________________________ __________________________________________ From_________To__________
Employer
Location (City and State)
Month/Year Month/Year
___________________________________________________ __________________________________________ From_________To__________
Employer
Location (City and State)
Month/Year Month/Year
9. Total semester hours for which you are registering this semester __________________________________________________________________________
East Tennessee State University is a Tennessee Board of Regents institution. ETSU is fully in accord with the belief that education and employment opportunities should be
available to all eligible persons without regard to age, sex, color, race, religion, national origin, or disability.
For Office Use Only
No. Hrs. Reg._________
Term & Year_________
Processed by: _______
Date: ______________
To The Applicant:
•
This form must be processed by the last day of registration of the semester (official census date) in order to be effective for that semester.
•
This statement and questionnaire are to be completed by the non-domiciled, part-time student,* who is seeking the waiver of out-of-state tuition on
the basis of full-time employment in the State of Tennessee according to regulations for classifying students in-state and out-of-state for the
purpose of paying university fees and tuition.
•
This statement must be verified by an official letter from the employer. THIS LETTER MUST STATE THAT THE EMPLOYMENT IS FULL-
TIME OR THAT A MINIMUM OF 37.5 HOURS ARE WORKED PER WEEK. INDIVIDUALS WITH MORE THAN ONE PART-TIME
EMPLOYER MAY QUALIFY BY PRESENTING MULTIPLE LETTERS INDICATING THAT THE NUMBER OF HOURS WORKED PER
WEEK EQUALS OR EXCEEDS 37.5. The letter should indicate the permanency and likelihood of continued employment.
•
*A "PART-TIME" GRADUATE STUDENT, including Non-Degree Seeking Students, must be registered for fewer than 9 hours per semester.
