California Nonresident Tuition Exemption Request

For Eligible California High School Graduates

 

Complete and sign this form to request an exemption from Nonresident Tuition. You must submit any documentation required by the College or University (for example, proof of high school attendance in California). Contact the California Community College, University of California or California State University campus where you intend to enroll (or are enrolled) for instructions on documentation, additional procedures and applicable deadlines.

 

ELIGIBILITY:

 

I, the undersigned, am applying for a California Nonresident Tuition Exemption for eligible California high school graduates at (specify the College or university)_______________________________and I declared the following:

 

Check YES or NO boxes:

 

□ Yes     □ No                      I have graduated from a California high school or have attained the equivalent thereof,

                                                such as a High School Equivalency Certificate, issued by the California State GED Office

                                                or a Certificate of Proficiency, resulting from the High School Proficiency Examination.

 

□ Yes     □ No                      I have attended high school in California for three or more years.

 

Provided information on all school(s) you attended in grades 9 - 12:

School

City

State

Dates:

From-Month/Year     To-Month/Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documentation of high school attendance and graduation (or its equivalent) is required by the University of California,

The California State University and some California Community Colleges. Follow campus instructions.

 

Check the box that applies to you -- check only one box:

 

□         I am a nonimmigrant alien as defined by federal law, [including, but not limited to, a foreign student (F visa)    

                or exchange visitor (J visa)].

 

                OR

 

□         I am NOT a nonimmigrant alien (including, but not limited to, a U.S. citizen, permanent resident, or an alien

                without lawful immigrant status).

 

AFFIDAVIT:

I, the undersigned, declare under penalty of perjury under the laws of the State of California 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 nonresident tuition exemption for eligible for California high school graduates. I hereby declare that, if I am an alien without lawful 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. I further understand that if any of the above information is untrue, I will be liable for payment and all nonresident charges from which I was exempted and may be subjected to disciplinary action by the College University.

 

Print Full Name (as it appears on your campus student records)

Campus/Student Identification Number

Print Full Mailing Address(Number, Street, City, State, Zip code)

Email Address (Optional)

 

Phone Number (Optional)

Signature

Date