Diversity Tuition Waiver Application

Illinois State University takes pride in its diverse student population and values diversity in all forms. In an effort to provide

support to persons from traditionally underrepresented groups who have been admitted to an Illinois State University

graduate degree program, the Graduate School is able to offer a limited number of Diversity Tuition Waivers.

Diversity Tuition Waivers are awarded competitively on a case-by-case basis to U.S. citizens from traditionally

underrepresented groups. Such groups may be based on but are not limited to race, ethnicity, religion, national origin, age,

sex, disability, sexual orientation, gender identity and expression, military experience, low socioeconomic status, experience

as a first generation college student, and/or limited English proficiency. Awards are not based solely on membership in one

or more traditionally underrepresented groups, but rather on a holistic evaluation that includes students' articulation of how

their experience and perspective as a member of an underrepresented group has resulted in and/or is expected to result in

unique contributions to their respective graduate program, academic discipline, and overall campus community. Waivers

are awarded subject to available funds and may be received in addition to most other types of financial assistance.

• You must be admitted to a degree program to apply. Students-at-Large are not eligible. You may apply for only one

semester at a time. You may submit a new application for each semester during which you are a registered degree-

seeking student.

• You must be in academic good standing with a GPA of at least a 3.00 to be awarded a waiver.

• Submit each year in the fall an updated personal statement that describes the specific action(s) you have

undertaken to achieve the results you described in your previous year's statement.

• Tuition waivers cover tuition only and not fees or other expenses.

• The waiver covers up to 9 hours of in-state tuition.

• If you receive a waiver then withdraw from all courses, you will be responsible for late withdrawal fee payments.

• If you are terminated from a degree program before the start of the semester of the waiver, the waiver will be

withdrawn.

• Tuition waivers cannot be applied to programs that are fee-based and not tuition-based, such as the Corporate MBA.

• You are required to apply for any employer reimbursement for all or part of your tuition first; any waiver will be reduced

by the amount of employer reimbursement.

Instructions: Submit your completed application and personal statement* to the address at the top of this page by these

priority dates for best chance at funding: Fall - July 1, Spring - October 1, Summer - March 1

ILLINOIS STATE

UNIVERSITY

Graduate School

309 Hovey Hall

Campus Box 4040

Normal, IL 61790-4040

Telephone: (309) 438-2583

Fax: (309) 438-7912

www.grad.illinoisstate.edu

Please note:

Continue to next page

Personal statement: You must submit a brief personal statement of no more than 250 words describing how your

experience and perspective as a member of an underrepresented group has resulted in and/or is expected to result in your

unique contributions to your respective graduate program, academic discipline, and overall campus community.

Instructions

Diversity Tuition Waiver

Application

UID No:

Name:

middle

last

first

Address:

State

street

Zip

City

Graduate program to which you have been admitted:

Female

Gender:

Male

Degree Sought:

Hispanic

Native American

Asian/Pacific Islander

I certify that the information in this application is correct. I authorize release for university use of this and other

information to verify my eligibility for a Tuition Waiver.

Date

Signature

FOR OFFICE USE ONLY:

Admitted to Degree Program: Y N

Current Graduate GPA:

Hours completed in program

Approved

TW Form Sent to Financial Aid

Letter Sent to Student:

Date

/By (initial)

Eff. 1/5/11

Black/African American

U.S. Citizen: Yes

White Non-Hispanic

Other

Email:

Phone:

Have you ever received a Diversity Tuition Waiver before? If yes, list all semesters of award:

If your employer offers professional development or tuition funds, you are required to apply for those benefits and use them

toward tuition in order to allow the university's limited Diversity Tuition Waivers to assist more students.

Are you currently employed? If yes, employer and job title:

Is any of the tuition for the semester for which you are applying eligible for employer reimbursement?

How much tuition will your employer reimburse?

If you are not certain, verify with the employer before answering the above items.

Yes

Eligibility check, Grad Specialist:

Dir. Grad. Studies:

Hrs. approved

Full-time or part-time? Employer's phone number:

Denied/Reduced, reason:

ILLINOIS STATE

UNIVERSITY

Graduate School

309 Hovey Hall

Campus Box 4040

Normal, IL 61790-4040

Telephone: (309) 438-2583

Fax: (309) 438-7912

www.grad.illinoisstate.edu

I. Student Information

II. Employer Information

Semester for which you are applying:

Number of hours to be enrolled?

Fall Spring Summer Year

Transgender

Choose not to disclose

Multi Racial

Have you applied for a tuition waiver through your department?

Yes No

Item Type: 900510004800

ILLINOIS STATE UNIVERSITY

STATEMENT OF REGISTRATION COMPLIANCE 2018-2019

FOR STATE OF ILLINOIS SCHOLARSHIP / GRANT RECIPIENTS

Academic Period Covered by Awards: July 1, 2018 to June 30, 2019

Please complete this form and return it to our office within thirty (30) days. Failure to do so will keep your military

awards(s) and/or other state scholarship(s) from being credited to your student account. If funds have already been

credited to your account, they will be debited and your next bill will show a balance owed.

UID Number:

Name:

Selective Service registration. You will not receive federal, state or other financial aid offered you unless

you complete this form and, if required, furnish proof to Illinois State University supporting your answer.

Mark ONE response. Do not leave this section blank.

I certify that I am registered with the Selective Service; OR

I .

I certify that I am not required to be registered with the Selective Service because:

I am female.

I have not reached my 18th birthday.

I was born before 1960.

I am in the armed services of the United States, on active duty. NOTE: Members of

the Reserves or National Guard are not considered to be ''on active duty.''

I am a permanent resident of the Federated States of Micronesia, the Marshall

Islands, or Palau.

I am not a citizen of the United States of America.

I am age 26 or over and gained United States citizenship on or after age 26.

WARNING: If you purposely give false or misleading information on this form, you may be fined,

sentenced to jail, or both.

Signing this statement certifies that all information reported is true, complete and accurate.

Student's signature (in black ink)

Today's date

Return your completed form to: Graduate School, 309 Hovey Hall, Campus Box 4040, Normal, IL 61790-4040

(Department)

08/21/08

- -