Cultural Diversity Tuition Waiver Application
Empl ID
FOR INSTITUTIONAL USE ONLY
1. Legal Name____________________________________________________________________________________________________________
2. Mailing Address_________________________________________________________________________________________________________
3. Email Address________________________________________________________Telephone__________________________________________
4. Permanent Address_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
5. Your Birthdate____________________________
6. Name of Parent, Guardian or Spouse_________________________________________________________________________________________
7. Classication at MSU (check appropriate box):
New Freshmen to MSU New Transfer to MSU Returning MSU student Re-applying to MSU
8. Academic program/major: ________________________________________________________________________________________________
9. Have you attended a North Dakota Tribal College? Yes No
Tribal College attended _________________________________ When attended ________________ Degree earned _______________________
Reason you are applying for a Cultural Diversity Tuition Waiver (For explanation of guidelines see second page)
Enrolled Member of a federally recognized American Indian Tribe or Alaska Native and Villages
What is your tribal afliation? ______________________________ North Dakota Minnesota Other___________________
NOTE: Documentation of enrollment must accompany this application.
American Indian who is not an enrolled member but has a direct lineal descent from an enrolled member of a federally recognized American
Indian Tribe or Alaska Native and Villages (NOTE: Do not check if you are an enrolled member of a federally recognized tribe.)
African American/Black having origins in any of the Black racial groups of Africa
Hispanic/Latino having Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origins
Asian/Pacic Islander having origins in any of the original peoples of the Far East, Southeast, Indian Subcontinent of the Pacic Islands
Multiracial/Multiethnic Please specify ____________________________________________________________________________________
Refugee or member of another traditionally underrepresented ethnic group Please explain ________________________________________
Economically disadvantaged - In order to select this option, the applicant must qualify for the federal Pell Grant.
My signature below certies that the above information is true and that any false information will result in the loss of the tuition waiver at any time.
_____________________________________________________________________ ___________________________
Please attach a statement about why you should be considered for this waiver.
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SIGNATURE OF APPLICANT
LAST FIRST MIDDLE FORMER NAME IF APPLICABLE
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PLEASE NOTE: Applicants must le a FAFSA to be considered for a Cultural Diversity Waiver.
Return to: Ofce of Enrollment Services, 330 Third St. NE, Mayville, ND 58257-1299
Cultural Diversity Tuition Waiver Program application procedures
Recognizing the educational benet of a culturally diverse student population, the State Board of Higher Education
adopted a tuition waiver program at Mayville State University. Special emphasis of this policy is to recruit, assist and
retain enrolled members of federally recognized American Indian tribes and Alaska Natives and Villages, graduates of
tribally controlled community colleges in North Dakota, and economically disadvantaged students. The Mayville State
University Institutional Diversity Statement further describes cultural diversity for this waiver program.
Eligibility
Applicant must meet one of the following denitions for eligibility under this program:
A. Be an enrolled member of federally recognized American Indian Tribes, or Alaska natives and Villages as
dened pursuant to the Alaska Native Claims Settlement Act; and as such constitute a political group ofcially
recognized by the United States government.
B. Be a member of a culturally diverse group which is dened as persons of different cultural, racial or ethnic
heritage, age, persons with disabilities and/or life experiences.
C. Persons who are economically disadvantaged, dened as persons who have a total family contribution not to
exceed 25% of North Dakota resident tuition of the previous year, based upon the federally prescribed
needs analysis formula.
Special emphasis will be given to:
A. Enrolled members of federally recognized American Indian Tribes, and Alaska natives and Villages; with
particular emphasis to enrolled members of the Spirit Lake Sioux Tribe, Three Afliated Tribes, Turtle Mountain
Band of Chippewa, and Standing Rock Sioux Tribe.
B. Graduates of North Dakota Tribal Colleges.
C. Individuals who are economically disadvantaged.
D. Beginning freshman and transfer students who are otherwise eligible.
Waiver guidelines
A. Past academic performance may be used in determining initial eligibility, and recipients must maintain
minimum academic standards for renewal.
B. Waivers will not exceed the amount of tuition. Tuition waivers do not include ight fees, application fees,
books, board, room or other costs of attendance.
C. Partial waivers may be awarded.
D. Generally, awards will be made for an academic year. Awards can be made for a longer or shorter duration.
E. Recipients shall be limited to a maximum of ve years as an undergraduate student.
F. Those recipients of Diversity Waivers who are attending classes on the Mayville State campus must be enrolled
full time (12 credits) and must also reside in campus housing during the terms that they receive a waiver. A
student who drops below 12 credits at any point in the semester will be required to repay the amount of the
waiver.
G. Those recipients of Diversity Waivers who are enrolled in off campus or collaborative programs must be
enrolled in at least six Mayville State credits during a term that they receive a diversity waiver. An off campus or
collaborative student who drops below 6 credits at any point in the semester will be required to repay the amount
of the waiver. Recipients enrolled as collaborative students will not receive a waiver of tuition for any credits
taken from another institution.
To Apply
A. Complete a Cultural Diversity Tuition Waiver Application. For top consideration this must be mailed before
March 15.
B. Complete a Free Application for Federal Student Financial Aid. For top consideration this must be processed
before March 15.
C. Attach a Verication of Tribal Enrollment, if appropriate.
