Fillable form to apply for AB 540 status as (San Diego Miramar College)

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form to apply for AB 540 status as (San Diego Miramar College)

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Distribution: Campus Residency
SS-AB540 12/2018
San Diego Community College District
California Nonresident Tuition Exemption Request
Fall Spring Summer Year:
Note: This form is accepted by all California Community Colleges and all campuses in the California State University system;
some University of California campuses will allow use of this form, but most require applicants to complete a campus-specific
form to apply for AB 540 status as amended by Education Code section 6813.5, effective January 1, 2018.
Instructions
Complete and sign this form to request exemption from nonresident tuition charged to nonresident students.
Once determined to be eligible, you will continue to receive the exemption as long as you fulfill eligibility
requirements or until the College or University no longer offers this exemption. Applying for this exemption does
not alter your responsibility to pay, by the campus deadline, any nonresident tuition and associated fees that may
be due before your eligibility is determined.
Application
I, the undersigned, am applying for the California Nonresident Tuition Exemption with the San Diego Community
College District
(select one):
San Diego City College San Diego Mesa College San Diego Miramar College
I declare that the following apply to me:
1) Check one box only:
I have a current nonimmigrant visa (not including a T and U visa) as defined by federal law.
Nonimmigrants have been admitted to the U.S. on a temporary visa and include, but are not limited to, foreign students
(holding F visas) and exchange visitors (holding J visas).
I have a current nonimmigrant visa as defined by federal law and have been granted T or U visa status.
I do NOT have a current, nonimmigrant visa as defined by federal law.
This includes, among other, U.S. citizens, permanent residents, DACA recipients, and individuals without current or valid
immigration status.
2) Select all items that apply to you from each column:
Column A
Column B
I attended a California high school for three (3) years
or more.
I have (3) or more years of high school coursework
and attend a combination of California elementary,
secondary, and high school of three (3) years or
more.
I attended a combination of California high school,
adult school, and community college for the
equivalent of three (3) years or more.*
I graduated with a California high school diploma (or
expect to graduate and use this exemption in the
following year) or have the equivalent (i.e. California-
issued GED, CHSPE).
I completed an associate’s degree from a California
Community College.
I completed the minimum requirements at a California
Community College for transfer to the California State
University or the University of California.
*A year’s equivalence at a California community college is either a minimum of 24 semester units of credit or 54 quarter units. For
noncredit courses, a year’s attendance is a minimum of 840 semester hours or 1,890 quarter hours. Full-time attendance at a
California adult school is a minimum of 420 hours of attendance for each school year.
Please provide information on the schools you attended and referenced above, including the dates you attended
and the number of credits or hours obtained:
Name of California School
Type of School
(high school, adult
school, or community
college)
City
Dates
Number of
Credit
Hours
From
(Month/Year)
To
(Month/Year)
Applicants must submit, as part of this form, official transcripts/attendance records that validate any of the
information above as requested by the College, District, or University residence officials.
Affidavit
By signing this document below, I hereby state that if I am a non-citizen without a current or valid immigration
status, I have filed an application to legalize my immigration status or will file an application as soon as I am
eligible to do so.
Declaration of True and Accurate Information
I, the undersigned, declare under the penalty of perjury that the information I have provided on this form is true
and accurate. I understand that this information will be used to determine my eligibility for the California
Nonresident Tuition Exemption. I further understand that if any of the above information is found to be false, I will
be liable for payment of all nonresident tuition charges from which I was exempted and may be subject to
disciplinary action by the College or University.
Student Name: Student ID Number:
(PRINT) as it appears on your college student records
Address:
Street City State Zip
E-mail: Telephone:
Signature: Date:
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form to apply for AB 540 status as (San Diego Miramar College)

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Completed 25 July 2020

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