Fee Waiver Form

1. Fee Waiver Request Form
Student Name: Student ID#: ____0 ______ _______
Student E-mail (required): ___ _______ Advisor Name:
Term/Class: Department:
Fee to be removed (Please Circle): (DROP) /Withdraw Fee Amount: ______________________
Registration Fee
Other (Please Specify) ______________
Comments (please be specific):
________________________________________________ _____________________
Student Signature Date
________________________________________________ _____________________
Advisor Signature Date
________________________________________________ _____________________
Advising Supervisor Signature Date
Office Use Only
Received by Cashier: ______________________________________________ Date: ____________
Cashier Supervisor: _______________________________________________ Date: ____________
Financial Affairs: _________________________________________________ Date: ____________
APPROVED DENIED