Last Name: 
First Name: 
M. I.          

Address:
City ST ZIP

Social Security No.          
Home Telephone Number

I am applying for the Cultural Diversity Tuition Waiver as a:

(Please check one only)

    New Student    Transfer Student    Returning Student

Please check all that apply:

        Culturally Diverse    Enrolled Member of a Federally Recognized Indian Tribe (Attach Verification of Tribal Enrollment)           Economically Disadvantaged

Are you applying for any of the following tuition assistance programs?

    JTPA    Vocational Rehabilitation    National Guard Tuition Assistance    Other

ACT Score

What is your Cumulative Grade Point Average (GPA)?

What is your class rank?  (High School Students Only)  

What degree(s) are you pursuing?

What college(s) will you be attending?
 

What is your cultural background?
 

What school activities have you been involved in?

What activities, outside of school, have you been involved in?

Please indicate below why you should be considered for this waiver: