Attachment II
Texas State
University-San Marcos
Tuition Rebate
Program – Hardship Justification
Beginning with fall 2005, enrolling students may participate
in the Tuition Rebate program without satisfying all eligibility requirements
if they demonstrate a hardship under any of the conditions listed below. The student must indicate which hardship
conditions they claim.
Section A – Student
Submit
this completed form to your College Academic Advising Center and obtain written
approval on this form. Attach this completed and approved form to the Tuition
Rebate Program Application and submit both 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 day. Note: The college dean or the supervisor of the
College Academic Advising Center may require written documentation of any of
the following hardship conditions claimed.
Hardship
claimed is: [circle one or more]
(a)
My own severe illness or other debilitating condition that has
affected my academic performance.
(b)
I am responsible for the care of a sick, injured, or needy person
and providing such care has affected my academic performance.
(c)
I have been performing active duty military service while pursuing
a degree at
Name: ________________________________ ID#:
__________________ Email:
______________________________
Local Address: ________________________________
________________________________
Local Phone: __________________________________ Permanent
Phone: _____________________________________
Semester of Graduation: _________________________
I hereby claim a hardship,
as indicated above, to qualify for a Tuition Rebate, as authorized under the
Tuition Rebate Program, in accordance with
____________________________________________________ _______________________
Signature Date
Section B – College Dean or Supervisor of the College Academic
Advising Center
I have reviewed the student’s
hardship claim and have made the following determination, as indicated:
□ Hardship Approved □ Hardship Denied – for the reasons indicated below.
Denied because
_____________________________________________________________________
Dean’s or
Supervisor’s name (print): ________________________________
College:
_____________________
____________________________________________________ _________________________________
Dean’s or
Supervisor’s Signature Date