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______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
_________________________________ _________________________________ _______________
Student Life Tuition Waiver Application
Return completed form to the BPCC Oce of Student Life (F220)
STUDENT ID # _____________________________ DATE OF BIRTH _____________________________
EMAIL ________________________________________________________________________________
TELEPHONE # _________________________ APPLICATION FOR ACADEMIC YEAR ________________
NAME ________________________________________________________________________________
LAST FIRST MIDDLE MAIDEN
PERMANENT ADDRESS __________________________________________________________________
CITY STATE ZIP
SEX Male Female
CITIZENSHIP
U.S. Citizen Permanent Resident Alien International student
LEGAL RESIDENT OF LOUISIANA Yes No If no, state of legal residency? ___________________
IF NOT ALREADY ENROLLED, WHEN DO YOU PLAN TO ENROLL AT BPCC?
Summer __________ Fall __________ Spring __________
YEAR YEAR YEAR
WHAT IS YOUR INTENDED MAJOR AT BPCC? _______________________________________________
HIGH SCHOOL GRADUATE? Yes No ___________ Date School ______________________
HISET
®
? Yes No Date ___________ School ______________________
CUMULATIVE GPA: High school __________ College __________
List any special talents, abilities, leadership qualities, and extracurricular achievements.
(Use additional sheets if necessary.)
Check which tuition waiver(s) you are interested in and a copy of this application will be forwarded to
the advisor of each organization indicated. A separate organization application may be required:
BPCC Debate Club BPCC Gospel Choir Cavalier Cheerleaders/Mascot
Cavalier Players Drama Club Communication Media Club Concert Choir & Chamber Singers
Instrumental Music Ensembles Ladies in Gold Danceline
Maroon Jackets
Ms. BPCC SkillsUSA Student Government Association
By signing below I authorize verification of my GPA and academic standing.
PRINT NAME SIGNATURE DATE
FOR OFFICE USE ONLY: GPA ______ HOURS ______
Bossier Parish Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees, diplomas, and certificates. Contact the Commission on
Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Bossier Parish Community College. • Bossier Parish Community College does not discriminate
on the basis of race, color, national origin, gender, age, religion, qualified disability, marital status, veteran’s status, or sexual orientation in admission to its programs, services, or activities, in access to them, in treatment
of individuals, or in any aspect of its operations. Bossier Parish Community College does not discriminate in its hiring or employment practices. • Coordinator for Section 504 and ADA: Angie Cao, Student and Disability
Services Specialist - Disability Services, 6220 East Texas Street, Bossier City, LA 71111 - (318) 678-6511 - acao@bpcc.edu - 8:00 a.m.–4:30 p.m. M-F, excluding holidays and weekends. • Equity/Compliance Coordinator:
Teri Bashara, Director of Human Resources - Human Resources Office, 6220 East Texas Street, Bossier City, LA 71111 - (318) 678-6056 - 8:00 a.m.–4:30 p.m. M-F, excluding holidays and weekends.
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