GEORGIA SOUTHERN UNIVERSITY PETITION FOR VOCATIONAL REHABILITATION OUT-OF-STATE FEE WAIVER Only students who are enrolled in a University System of Georgia institution based on a referral by the Vocational Rehabilitation Program of the Georgia Department of Labor are eligible for this waiver. NOTE: This petition is for informational purposes only and does not in any way imply a determination of legal residence in Georgia.

Please complete the following section. Student Information: Full Name

Eagle ID#

Address

Phone Street

Term Applying for:

City

State

Zip

201

The undersigned affirms the authenticity of the information provided in this petition. I understand that any false or misleading information on this petition could result in the cancellation of this waiver and I may be required to pay out-of-state fees for the current term as well as previous terms. Signature of Student

Date

Subscribed and sworn to me before this :

201

Notary Public

My commission expires on

YOU MUST INCLUDE: 1) A copy of your referral by the Vocational Rehabilitation Program of the Georgia Department of Labor. 2) Lawful Presence Verification form - see next page for details. NOTE: This waiver is valid for a period of 12 months and must be renewed at the end of that period.

NEW undergraduate students should submit waiver & documentation to: Stephanie del Forn Georgia Southern University Office of Admissions P. O. Box 8024 Statesboro, GA 30460 Phone: 912-478-2303 Fax: 912-478-1156 [email protected]

NEW graduate students should submit waiver & documentation to: Naronda Wright Georgia Southern University Office of Admissions P. O. Box 8113 Statesboro, GA 30460 Phone: 912-478-5384 Fax: 912-478-0740 [email protected]

12/17/14 tlp

CURRENT undergraduate and graduate students should submit waiver & documentation to: Tifani L. Pool Georgia Southern University Office of the Registrar P. O. Box 8092 Statesboro, GA 30460 Phone: 912-478-0283 Fax: 912-478-5712 [email protected]

LAWFUL PRESENCE VERIFICATION FORM In accordance with Board of Regents Policy 4.3.4, all applicants who are awarded in‐state tuition classification or any out‐of‐ state fee waiver from Georgia Southern University for Fall 2011 or any academic semester thereafter are required to provide validation of lawful presence in the United States. At this time, we do not have documentation on file to verify your lawful presence in the United States. Because of this, we need more information before we can award you in‐state tuition status or out‐of‐state fee waiver. Please complete this form, include clear and legible photocopies of applicable materials (note that some require you provide a certified original), and return the packet as soon as possible. If the documents are not received by the first day of classes, you will be subject to out‐ of‐ state/country fees. Thank you for your prompt attention to this matter. Please submit one of the following documents: DOMESTIC STUDENTS: ( ) A current ID or drivers’ license issued by the State of Georgia after January 1, 2008 ( ) A certified U.S. birth certificate showing that the student was born in the U.S. or a U.S. Territory A photo copy is not acceptable. You may obtain a certified copy through the Health Department in the county in which the student was born. ( ) A U.S. Certificate of Birth Abroad issued by the department of state or a Consular Report of Birth Abroad. ( ) A U.S. Certificate of Naturalization or Certificate of Citizenship ( ) A current U.S. Passport ( ) A current Military ID (must present in person) ( ) A current Permanent Resident Alien Card INTERNATIONAL STUDENTS: Country of Origin: ( ) Visa type currently held ( ) A current Permanent Resident Alien Card

I certify that the document provided to verify my lawful presence is true to the best of my knowledge. I understand that omissions or misrepresentations will automatically invalidate the awarding of my in‐state tuition classification/out‐of‐state fee waiver at Georgia Southern University. Signature

Date

12/17/14 tlp

Vocational Rehabilitataion Waiver 2015.pdf

... lawful presence is true to the best of my knowledge. I understand that. omissions or misrepresentations will automatically invalidate the awarding of my in‐state tuition classification/out‐of‐statefee. waiver at Georgia SouthernUniversity. Signature Date. 12/17/14 tlp. Page 2 of 2. Vocational Rehabilitataion Waiver 2015.pdf.

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