FC AB540 Affidavit - Workflow Header Image

California Nonresident Tuition Exemption Request

(Education Code section 68130.5, commonly known as AB 540 Effective Jan. 1, 2018)

INSTRUCTIONS

Complete and sign this form to request an 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.

Please note (*) indicates required fields.



APPLICATION

Name*

I, the undersigned, am applying for the California Nonresident Tuition Exemption at Fullerton College and declare that the following apply to me.



1) Check one box:*



2.) Select all items that apply to you from each column (must satisfy at least one from each column to be eligible):

Column A*
Column B*


++ A year’s equivalence at a California Community College is either a minimum of 24-semester units of credit or 36 quarter units. Only two (2) years of full-time attendance in credit courses at a California Community College will count toward the three (3) or more years of attendance. For non-credit courses, a year’s attendance is a minimum of 420 class hours per year (a semester is equivalent to a minimum of 210 hours and a quarter is equivalent to a minimum of 140 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 on the previous page, including the dates you attended and the number of credits or hours obtained:

     

Attended From:*
Attended To:*
Put N/A if you are unsure, we will review transcripts if necessary

     

Attended From:
Attended To:
Put N/A if you are unsure, we will review transcripts if necessary

     

Attended From:
Attended To:
Put N/A if you are unsure, we will review transcripts if necessary
Would you like to add any additional schools?*

     

Attended From:
Attended To:
Put N/A if you are unsure, we will review transcripts if necessary
Would you like to add any additional schools?*

     

Attended From:
Attended To:
Put N/A if you are unsure, we will review transcripts if necessary

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 official.



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 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.

Name*

Use your mouse or finger to draw your signature above
Date/Time
:  

Office Use:

The Student Above has met the requirements for the California Nonresident Tuition Exemption Request:*
Date/Time
:  
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