Attachment I


Texas State University-San Marcos

Tuition Rebate Program Application


Section A – Student


Submit this completed rebate application to your College Academic Advising Center no sooner than the first day of the semester in which you graduate and no later than the workday immediately preceding your graduation date. Texas law requires students to apply for rebates PRIOR to receiving their baccalaureate degrees and provide current address information for 60 days after graduation.


Name: ________________________________                                                        ID#: __________________             Email: _____________________________


Local Address: ________________________________     Permanent Address:    _________________________________

                                                                                                            (check will be mailed here)

                            ________________________________                                             _________________________________


Local Phone:    __________________________________ Permanent Phone:   ___________________________________


Semester of Graduation:    _________________________


Major (1st):        __________________________________     Minor (1st):                _________________________________


Major (2nd):       __________________________________     Minor (2nd):               _________________________________


I hereby request a Tuition Rebate, as authorized under the Tuition Rebate Program, in accordance with Texas Education Code 54.0065, for the first baccalaureate degree I’ve earned.  I have been a resident of Texas and entitled to pay resident tuition at all times while pursuing the degree, and will provide appropriate documentation when requested.  I understand that the amount of the rebate will not exceed $1,000 and is limited to only those amounts paid by me for Education and General tuition (excluding financial aid).  I also agree that the university will first apply the rebate to all outstanding obligations to Texas State University-San Marcos and the State of Texas.  I will contact the Student Business Services Office if I have a preference to the order the rebate is applied to my outstanding obligations.  I will receive the remaining balance after such debts are paid.  Unless I specify otherwise, I agree that the university will forward any rebate I am eligible to receive to my permanent address on file at the university.  I authorize Texas State University-San Marcos to access my educational and financial records at other institutions of higher education to determine my eligibility for a Tuition Rebate.  I authorize Texas State University-San Marcos to discuss this application with me by telephone or e-mail, using the phone number and e-mail address maintained at the university.


____________________________________________________       _______________________

Signature                                                                                  Date


Section B – College Dean or Supervisor of the College Academic Advising Center


This student’s academic records have been reviewed and, for this program, the student is:


¨  Eligible                                        Name and Title: ______________________________________________________

¨  Not eligible                               College: ______________________________________________________________


____________________________________________________       _______________________

Dean’s or Supervisor’s Signature                                             Date


Section C – Accounting Office


Reviewed by:


____________________________________________________       _______________________

Signature                                                                                  Date