APPLICATION FEE WAIVER REQUEST FORM OFFICE OF

Qualied applicants who are U.S. citizens, permanent residents and foreign nationals residing in the United

States with documented membership in approved programs or demonstrated nancial need may request

an application fee waiver. Please note that waivers are very limited. Apply early.

The following are examples of qualied organizations:

• AmeriCorp or City Year Volunteer

• Annual Biomedical Research Conference for Minorities Students (ABRCMS)

• Fulbright Scholars

• Gates Millennium Scholars

• McNair Scholars

• Minority Biomedical Research Support Program (RISE)

• PeaceCorp Volunteers

• Society for the Advancement of Chicanos and Native Americans in Science (SACNAS)

• Teach for America Volunteers

• Applicants who fall below the federal poverty guidelines

Applicants must complete the Fee Waiver Request Form, submit a copy of their latest 1040, 1040EZ, or

4506T-EZ tax form and documentation of scholarship or volunteer participation. Please submit a waiver

form and required documents to [email protected].

APPLICATION FEE WAIVER REQUEST FORM

GRADUATE PROGRAM

BASIS FOR YOUR REQUEST (applicants may attach a letter if necessary)

LAST NAME

CURRENT STREET ADDRESS

FIRST NAME

APPLICATION SEMSESTER

CURRENT CITY, STATE AND POSTAL CODE

BIRTHDATE

DATE

MOBILE

OFFICE OF GRADUATE STUDIES