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 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