Attachment II

 

Texas State University

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 later than 30 business days after the date the college dean or supervisor of the college academic advising center determines ineligibility. Note: The college dean or the supervisor of the college academic advising center requires 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 Texas State.

 

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 Texas Education Code 54.0065.

 

 

____________________________________________________     _______________________

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