UPPS 03.01.13 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.
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
____________________________________________________ _______________________
Signature Date
Section B – College Dean or Academic Advisor II
This student’s academic records
have been reviewed and he/she is eligible/not eligible for this program.
¨
Eligible Name and Title: ______________________________________________________
¨
Not eligible College: ______________________________________________________________
____________________________________________________ _______________________
Signature Date
Section C – Accounting Office
Reviewed by:
____________________________________________________ _______________________
Signature Date