Texas State University-San Marcos
Tuition Rebate Program – Hardship Justification
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.
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
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): ________________________________
Dean’s or Supervisor’s Signature Date