Fillable Superior Out Of State Student

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Superior Out Of State Student

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ALBANY STATE UNIVERSITY
APPLICATION FOR OUT-OF-STATE TUITION DIFFERENTIAL WAIVER
ACADEMICALLY SUPERIOR STUDENTS
NOTE: This waiver is valid for one academic year. Partial year awards are based on availability. Completion
of the application does not guarantee the award of a waiver. Please apply early for best consideration.
For more information, review the requirements on the ASU Registrar’s website or call 229-500-4358.
Section I – To be completed by the STUDENT
Name:
Student ID:
Address:
City:
State:
Zip:
Email:
Phone:
Term applying for waiver: Fall Spring Summer Year:
Major: _________________________________ Are you interested in Living on campus? Yes No
GPA: ____________________ Classification: Graduate
Undergraduate: Freshman Sophomore
Junior Senior
In 300 words or less, please describe why you want this waiver, why you want to attend Albany State,
and how this tuition waiver will help you succeed.
Rev. 04/30/19
Section II – STUDENT Oath and Affirmation
I understand that any material false statement made knowingly and willingly by me on this application, or any
documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a
person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000
or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of
law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from
the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and
complete.
Student Signature Date
Submit completed form and required documentation to:
Office of Global Programs
ATTN: Tuition Waiver Officer
Albany State University
2400 Gillionville Road
Albany, GA 31707
OR
Office of the Registrar
ATTN: Tuition Classification Officer
Albany State University
2400 Gillionville Road
Albany, GA 31707
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Superior Out Of State Student

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Completed 28 January 2020

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