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

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

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