Please Complete the Following Section

Active U.S. National Guard and Mail or Deliver In-person to: The Office of the Registrar, Military Reserves Waiver 224 Sparks Hall, Term Priority Final P.O. Box 4017, Atlanta, Georgia Fall Semester Jun 1 Aug 1 30302-4017 Or Email Spring Semester Nov 1 Dec 1 Waiver and supporting Summer Semester Mar 1 May 1 documentation in PDF format to Waivers filed after the final deadline will be considered for the subsequent semester. [email protected] If petition is approved, classification will not be retroactive to prior semesters. This waiver is valid as long as the student remains continuously enrolled. Active members of the Georgia National Guard stationed/assigned to Georgia or active members of a unit of the U.S. Military Reserves based in Georgia can be considered for this waiver. This waiver may also be granted to a spouse and dependent children. Please complete the following section: Student’s Name: . Panther # . Address: . . . . Street City State Zip Phone: (. ) . - . GSU Email: .

☐ ☐ Term Applying for: ☐ Fall Spring Summer 20.

Submission of the following documentation does not guarantee eligibility for a Waiver of Non-Resident Fees. ALL supporting documents must be included with the application for Waiver. Failure to submit all documents may result in an unfavorable decision. Documentation to submit with this application For the military member, spouse, or dependent child  A letter/preprinted form or copy of orders must be submitted to verify the military member is stationed in or assigned to Georgia. o If the National Guard or Military Reserves member is a noncitizen, documentation of current legal immigration status. And one of the following: 1. A letter or preprinted form verifying active duty status. 2. Copy of orders to verify current active status. 3. Copy of Enlisted Record Brief (ERB) or Officer Record Brief (ORB). For the spouse of the military member  Documentation verifying citizenship or current legal immigration status for spouse is required In addition to the documents above, one of the following documents must be submitted to establish dependency:  Certified copy of current year Federal Income Tax form 1040 for the military personnel, filing as “Married filing jointly” or “ Married filing Separately”  Copy of marriage certificate.  Copy of DD1172 (DEERS – Defense Eligibility Enrollment Reporting System form). For dependent children of the military member  Documentation verifying citizenship or current legal immigration status for parent or guardian is required In addition to the documents above, one of the following documents must be submitted to establish dependency:  Certified copy of current year Federal Income Tax form 1040 for the recently separated military personnel with child listed as dependent.  Copy of birth certificate.  Copy of U.S. court documentation of guardianship.  Copy of DD1172 (DEERS – Defense Eligibility Enrollment Reporting System form). All documents submitted become the property of Georgia State University and cannot be returned. Please submit copies, not original documents. 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. Furthermore, I authorize Georgia State University to review or examine any documents and records, including my confidential loan forms and related data, which may assist in clarifying my eligibility for a Waiver of Non- resident Fees. I understand that all supporting documents submitted for evaluation become the property of Georgia State University and are not returnable. Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete. . . Student’s Signature Date