Senior Citizen Tuition Waiver Request (A)

SENIOR CITIZEN TUITION WAIVER REQUEST
Submission ID
Accessibility Statement

Delgado Community College is committed to digital accessibility. This form is designed to be compatible with assistive technologies and follow accessibility standards. If you encounter any barriers or need an alternative format to provide your signature, please contact us by emailing the Bursar's Office at bursaroffice@dcc.edu.
Tuition is waived for Louisiana residents 60 years and over for one three-credit-hour course each semester/session (no auditing or non-credit).

Eligible students must provide a valid state issued ID and have met the age requirements by the first day of the semester or term.
STUDENT REQUEST INFORMATION
Semester*
Student Name*

First NameLast Name
Student LoLA ID:*
L01234567
Student Email:*

Confirmation Emailexample@dcc.edu
Waiver Type:*
Date of Birth*

MonthDayYear
Current Date

MonthDayYear
Age
To be completed by Accounts Receivable
Entered:
Verified By:
Age Requirement:
Status:
Comments/Requirements:
Verification Date:

MonthDayYear
Copy of valid State Issued ID:*

Cancelof
Additional Comments:
Optional
STUDENT AUTHORIZATION
Student Certification:*

I hereby certify that I will be 60 years of age or older by the first day of the semester or term requested above.I understand that the tuition waiver is for a maximum of three(3) credit hours of Tuition only and does not cover legislatively mandated fees, board authorized fees, student or school imposed fees, or any other charges.
Third Party FERPA Disclosure:*

I authorize Delgado Community College to release necessary financial and educational information, in the manner requested, to the State, Local, or Federal Agency for the purposes of certifying my eligibility.
Terms and Conditions:*

I understand that if it is later determined that I do not meet eligibility requirements, the waiver may be removed from my account and I will be required to pay the full amount due by the published or assigned due date(s).I promise to pay for all fees not covered by this waiver by the published or assigned due date(s). In the event the student becomes delinquent in paying charges or defaults in repaying charges, the debts may be transferred to the State of Louisiana Attorney General’s Office, the Louisiana Office of Debt Recovery, or another external agency for collection. All collection fees incurred shall be at the expense of the student which may be based on a percentage at a maximum of 33 1/3%. If Delgado prevails in a law suit to collect on the student’s financial obligation, the student will be responsible to pay Delgado’s court costs, collection fees and attorney’s fees in an amount the court finds to be reasonable.
Signature* Student: Please sign by clicking the signature line and signing this form.
Type Name*
*Once you enter your name you will not be able to make any changes to this request.
Date*

MonthDayYear
Please verify that you are human*
Should be Empty:

SENIOR CITIZEN TUITION WAIVER REQUEST

STUDENT REQUEST INFORMATION

To be completed by Accounts Receivable

STUDENT AUTHORIZATION