Texas State University Tuition Rebate Program Application

Section A ? Student

Texas State University Tuition Rebate Program Application

Submit the Tuition Rebate Application to your college academic advising center no later than 5:00 p.m. on the

Monday immediately following your commencement. If you do not graduate because you did not meet the

graduation requirements, you will need to complete another form for the next semester in which you are

eligible.

Name

ID#

Bobcat Email

Personal Email

Local Address

Permanent Address

Cell Phone

Permanent Phone

Semester of Graduation

Major (1st) Major (2nd)

Minor (1st) Minor (2nd)

I hereby request a Tuition Rebate, as authorized under the Tuition Rebate Program, in accordance with Texas Education Code 54.0065, for the first baccalaureate degree I've earned. I have been a resident of Texas and entitled to pay resident tuition at all times while pursuing the degree, and will provide appropriate documentation when requested. I understand that the amount of the rebate will not exceed $1,000 and is limited to only those amounts paid by me for Education and General tuition (excluding financial aid). I also agree that the university will first apply the rebate to all outstanding obligations to Texas State University and the State of Texas. Unless I specify otherwise, I agree that the university will forward any rebate I am eligible to receive to my permanent address on file at the university. I authorize Texas State University to access my educational and financial records at other institutions of higher education to determine my eligibility for a Tuition Rebate. I authorize Texas State University to discuss this application with me by telephone or e-mail, using the phone number and e-mail address maintained at the university.

Signature

Date

Section B ? College Dean or Supervisor of the College Academic Advising Center

This student's academic records have been reviewed and, for this program, the student is:

Eligible Not eligible

Name and Title: College:

Dean's or Supervisor's Signature

Date

Section C ? Student Business Services Office Reviewed by:

Signature

Date

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