Office of Admissions and Records
California Nonresident Tuition Exemption Request
(supplementary form for adult school students)
ELIGIBILITY: If you attended adult school for three or more years and have attained a High School
Equivalency Certificate issued by the California State GED Office, or a Certificate of Proficiency
resulting from the California High School Proficiency Examination, complete this form and submit
it with the green Calfornia Nonresident Tuition Exemption Request form.
Provide information on all adult school(s) you have attended:
Adult School
City
State
Dates:
From - Month/Year To - Month/Year
AFFIDAVIT:
I, the undersigned, declare under penalty of perjury under the laws of the State of California that
the information I have provided on this form is true and accurate.
Print Full Name (as it appears on your campus student records)
Social Security Number or Datatel ID Number
Signature
Date
Note: Complete all sections of the green Calfornia Nonresident Tuition Exemption Request form
and submit it, together with this form, to the Office of Admissions and Records for determination
of your eligibility for the nonresident tuition exemption.