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 Texas Education Code 54.0065. I have been eligible to pay tuition at the resident rate at all times while pursuing the degree. I understand that the amount of the rebate will not exceed $1,000 and is limited to only those amounts paid by me for E&G tuition (excluding financial aid). I also agree that the rebate will first be applied to all outstanding obligations to Texas State University-San Marcos and the State of Texas. After such debts are paid, the remaining balance will be paid to me.

 

 

 

____________________________________________________       _______________________

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