Social Security Certification For Credit Tuition Waiver Form printable pdf download

Social Security Certification For Credit Tuition Waiver Form

Name:

AACC ID#:

I certify that the above-named individual is out of the workforce as a result of a permanent

disability and is receiving a social security disability benefit (SSDI) or supplemental security

income (SSI) as defined by the Social Security Act, Railroad Retirement Act, or in the case of a

former federal employee, the federal retirement or pension authority (U.S. Office of

Personnel Management).

Individuals receiving SSI or SSDI benefits as a dependent or survivor of a disabled beneficiary

do not qualify for this waiver.

Place Office Stamp in Box

Printed Name & Title of Certifying Official

Signature of Certifying Official

Phone Number of Certifying Official

Date

Student Signature

Student Signature authorizes the Social Security Administration (Railroad Retirement Board, or

U.S. Office of Personnel Management) to release information on the above named individual

and acknowledges that this form is valid for one academic year and must be renewed each

academic year. In addition, student acknowledges that he/she must apply for financial aid.

Return ORIGINAL completed form with signature and stamp to the Cashier's Office:

Cashier's Office (Student Services Center, 1st Floor)

Anne Arundel Community College

101 College Parkway

Arnold, MD 21012

Social Security Certification For Credit Tuition Waiver Form