Senior Citizen Waiver Form Revised June 10, 2020
Senior Citizen Education Tuition Program Fee Waiver Form
Proof of Status: To be eligible for waiver of tuition and fees, person seeking the Senior Citizen Education
Program must meet the following criteria: Be at least 60 years of age, must show senior citizen ID card
issued by the Unites Stated Virgin Islands Department of Human Services, and be a resident of the United
States Virgin Islands for at least one year. (Undergraduate Catalog 2014-2015, pp. 27-28).
SEMESTER (indicate one)
Fall Spring Summer Session(s) I or II Year__________
Name of Student: ________________________________________ Student ID Number: _____________
Mailing Address: _______________________________________________________________________
City: _____________________________________________ State and Zip: ________________________
Requested Courses Pre-requisites*
1. _________________________________ ______________________________
2. _________________________________ ______________________________
3. _________________________________ ______________________________
4. _________________________________ ______________________________
5. _________________________________ ______________________________
6. _________________________________ ______________________________
*Pre-Requisites may be required for courses.
Student Signature: _______________________________________________ Date: _____________
Registrar Office Signature: ___________________________________________ Date: _____________
For Business Office Use Only: Total Credits: ______________ Tuition Amount: _________________
For Registrar’s Office Use Only:
Senior Citizen Card ID#_____________________________ Expiration Date: ____________________
Proof of Age:
□ yes □ No
Degree Student:
□ yes □ No
Proof of Residence:
□ yes □ No
Non-Degree Student:
□ yes □ No
Credit Total:
□ yes □ No
Access and Enrollment Services
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