Special Application For 540 Students Under The California Form
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4Special Application for 540 Students Under the California Dream Act
California Community Colleges 2012-2013 Board of Governors Fee Waiver Application
Under the provisions of AB 131, students who are exempt from paying nonresident tuition under Education Code Section
68130.5 (AB 540) are eligible to participate in the BOG Fee Waiver program for terms beginning on or after January 1, 2013.
If you have not had your AB 540 status determined by Admissions or the Registrar please see one of those offices to obtain
the valid determination. Fee Waiver eligibility cannot be determined until your AB540 status is verified.
Has the Admissions or Registrar's Office determined that you are exempt from paying nonresident tuition under Education
Code Section 68130.5 (AB 540)?
Yes No
This is an application to have your ENROLLMENT FEES WAIVED. Please see the financial aid office or scholarship office for details
on what additional aid may be available.
Name:
Student ID #
Last
First
Middle Initial
Email (if available):
Telephone Number: (______)
Home Address:
Date of Birth:
_______/_______/_________
Street
City
Zip Code
IMPLEMENTATION OF THE CALIFORNIA DOMESTIC PARTNER RIGHTS AND RESPONSIBILITIES ACT
The California Domestic Partner Rights and Responsibilities Act extends rights, benefits, responsibilities and obligations to individuals
in domestic partnerships registered with the California Secretary of State under Section 297 of the Family Code. If you are in a
Registered Domestic Partnership (RDP), you will be treated as an Independent married student to determine eligibility for this
Enrollment Fee Waiver and will need to provide income and household information for your domestic partner. If you are a dependent
student and your parent is in a Registered Domestic Partnership, you will be treated the same as a student with married parents and
income and household information will be required for the parent’s domestic partner.
If you or your parents are in a Registered Domestic Partnership please see the financial aid office for further instructions on
completion of this form.
DEPENDENCY STATUS
The questions below will determine whether you are considered a Dependent student or Independent student for fee waiver eligibility
and whether parental information is needed. If you answer “Yes” to ANY of the questions 1-10 below, you will be considered an
INDEPENDENT student. If you answer “No” to all questions, you will be considered a Dependent student thereby reporting parental
information and should continue with Question 11.
1. Were you born before January 1, 1989?
Yes No
2. As of today, are you married or in a Registered Domestic Partnership (RDP)?
(Answer "Yes" if you are separated but not divorced or have not filed a termination notice to dissolve partnership.
Yes No
3. Are you a veteran of the U.S. Armed Forces or currently serving on active duty for purposes other than training?
Yes No
4. Do you have children who will receive more than half of their support from you between July 1, 2012-June 30, 2013, or other
dependents who live with you (other than your children or spouse/RDP) who receive more than half of their support from you, now
and through June 30, 2013?
Yes No
5. At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward
of the court?
Yes No
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