Nonresident Tuition Waiver Application

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Clifton Francis
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Nonresident Tuition Waiver Application Family name: Given name(s): International Student and Scholar Services Georgia State University Sparks Hall, Suite 252 Atlanta, GA 30302-3987 Tel: 404-413-2070

1 Nonresident Tuition Waiver Application Family name: Given name(s): International Student and Scholar Services Georgia State University Sparks Hall, Suite 252 Atlanta, GA Tel: Web: isss.gsu.edu Panther ID Number: - - I. Applicant Criteria: 1. Georgia State University 3.0 Grade Point Average 2. Previously enrolled at Georgia State University for a minimum of one academic year (two semesters). 3. Enrolled in a degree program. 4. Must be within one academic year (two semesters) of completion 5. F-1 or J-1 Immigration status. 6. Demonstrate financial need, student self-help, and balance of awards from other sources. 7. Students in academic programs that do not distinguish between in-state and out-of-state tuition (Intensive English Program, Global Partners MBA) are NOT eligible. II. Required Documentation: You will upload this form along with all supporting documentation as 1 single document into istart. Prepare all supporting documents as PDF s BEFORE uploading the materials. If your application will not include a part of the required documentation (ex: car info, or a lease if you live with family) prepare a statement as a PDF document to explain why and put that with your other documentation to be uploaded. A cover sheet with the contents of your application may be helpful. Label each extra document clearly to reference the relevant section. 1. Personal Statement: 1-2 pages, double spaced. Explain your need for this waiver. Include any recent changes in your financial situation and why you cannot meet your funding needs. Include supporting documents and/or proof of circumstances. 2. Housing Documents: Copy of current lease of an explanation if no lease. 3. Financial Documents: A. Copies of your bank statements for the past 3 months. B. Explain all withdrawals over US$ Automobile Documents (if applicable): Indicate year, make, and model of car. Provide copy of auto tag receipt and auto insurance card. If you do not own or operate a personal vehicle, indicate how you travel to and from campus. If MARTA, for example, provide a copy of your Breeze Card and a recent receipts for payment. Note: ISSS is NOT able to make copies of documents. III. Confirm Semester and Year of this Tuition Waiver Application: IV. Would you like the notice of outcome of your application mailed or will you pick it up in ISSS? V. Personal Information: 1. City of Birth: 2. Country of Citizenship: 3. Marital Status: Married 4. Gender: Male 5. Date of Birth (MM/DD/YYYY): / / Single Female 6. Local Mailing Address: (street + apartment / unit # if applicable) (City) (State) (Zip Code) ISSS, 09/03/15 Page 1 of 5

2 7. Telephone :( ) - 8. GSU 9. First Semester at Georgia State: Semester: Year: 10. Expected Date of Graduation: Semester: Year: 11. Program of Study (Major): 12. Current Degree Sought: Undergraduate Graduate 13. Type of Visa: Student (F-1 or J-1): Other Visa Type (if applicable) If J-1 Exchange Visitor, indicate your program sponsor: 14. Dates of holidays inside and outside the U.S.: (List all travel since coming to the U.S. for full-time study): Date departed Date returned Destination Purpose VI. Financial Information: 1. Are you entirely self-financed (Do you pay all of your costs yourself?) Yes No 2. Do you pay resident tuition through university employment or a scholarship? Yes No If yes, will in-state tuition be in effect during the semester(s) of your waiver application? Yes No 3. Do you have a scholarship or fellowship that pays any part of your tuition or provides a stipend? Yes No If yes, list type and amount of assistance per semester: 4. Have you applied for an academic position in your department? Yes No If yes, was authorization granted? Yes No 5. List all financial support / assistance that you have received (include previous tuition waivers): Date applied Source Date or semester received 6. Have you been, or are you currently employed in the U.S.? Yes No If yes, provide the following information: a. Name of employer: b. Start date: c. End date: d. Salary: 7. How much money do your receive from your family, sponsor, and/or employer each year? 8. Do you own a car? Yes No a. If Yes, provide year, make and model: b. Name of insurance company (upload copy of your tag receipt): ISSS, 09/03/15 Page 2 of 5

3 9. If you do not have a car, what type of transportation do you use to come to Georgia State University? 10. Do you have dependents in the U.S.? If so, please list them below: Full Name Relationship to you Citizenship Age 11. If you are married, is your spouse employed? Yes No a. If yes, spouse s employer: b. Spouse s monthly salary: c. Is your spouse a student? Yes No 12. If you are not financially self-supported, provide the following information: a. Name of Primary Financial Sponsor(s): (i.e., parent(s) or relative s name, foreign university or government agency, etc.) b. Relationship to you: c. Address: d. Occupation/Title: e. Employer: g. Currency and Annual Salary in that Currency: h. Value of the above salary in US$: 13. If your primary financial sponsor is a parent or relative, give the following information: a. Is your sponsor a: U.S. Permanent resident U.S. citizen H visa holder Other (explain) b. How many persons, including yourself, depend upon the income of your sponsor for daily living expenses? c. List these family members below. Do not include yourself. Full Name Relationship to you Age ISSS, 09/03/15 Page 3 of 5

4 VII. Personal Budget 1. Estimated Income and Financial Support (in U.S. Dollar Amounts) Summer 2016 Fall 2016 Spring 2017 Personal and/or family support Government Sponsor or Loan Agency GSU scholarship/assistantship Income from Employment Other: Total financial support: $ $ $ 2. Estimated Expenses Summer 2016 Fall 2016 Spring 2017 Tuition & Fees Housing Food Books & Supplies Dependent care Miscellaneous Total financial Expenses: $ $ $ By signing this form I (type your name): certify that all of the information provided is true and correct to the best of my knowledge. I will inform ISSS of any changes in the financial information I have provided. I understand that providing false or inaccurate information on any part of this form will disqualify me from all future waiver applications. It may also result in disciplinary action, loss of financial aid, and could even affect my immigration status. Signature: Date: / / ISSS, 09/03/15 Page 4 of 5

5 CHECKLIST FOR: NON- RESIDENT TUITION WAIVER APPLICATION TO ISSS This checklist is provided to help you confirm that all parts of your application are ready. You do not need to include this checklist with your application. It is for your reference only. Please ensure you have included ALL applicable documents at the time of upload to istart! Did I include a detailed statement explaining the change in my financial circumstances? Did I include documents to support my statement, including, but not limited to, newspaper articles, death certificates, currency exchange rates? Did I include a copy of my lease agreement or an explanation of why I don t have one? Did I include copies of bank statements for the past 3 months with explanations of large withdrawals and deposits? Did I include a copy of my tag receipt and proof of car insurance (if applicable)? Did I include any additional information that will be helpful to the ISSS Tuition Waiver Committee in reviewing my application? Are all of my extra documents clearly labelled so that they clearly correspond to a particular part of the application? ISSS, 09/03/15 Page 5 of 5

!! PLEASE WRITE VERY CLEARLY TO AVOID PROCESSING DELAYS!!

!! PLEASE WRITE VERY CLEARLY TO AVOID PROCESSING DELAYS!! International Student Financial Verification Form International Programs (IP) at Clayton State University requires each international applicant to document their ability to fund the first full year of