California Community Colleges
BOARD OF GOVERNORS ENROLLMENT FEE WAIVER APPLICATION
2005-2006

This is an application to have your enrollment fees waived. This fee waiver is for California residents only. If you need money to help with books, supplies, food, rent, transportation and other costs, please complete a FREE APPLICATION FOR FEDERAL STUDENT AID (FAFSA)  right away. Contact the Financial Aid Office for more information. The FAFSA is available at www.fafsa.edu.gov or at the Financial Aid Office. It’s OK to file both this form (for quick action) and the FAFSA (to be considered for more money). You must fill out this form by and then mail or fax it in, with proof of income).  FOR YOUR CONVENIENCE THIS FORM MAY BE FILLED OUT ONLINE.  IT CAN NOT BE SUBMITTED ONLINE!  IT MUST BE MAILED OR FAXED TO THE COLLEGE. MAIL THE FORMS TO FINANCIAL AID 2700 BARSTOW ROAD, BARSTOW, CA 92311 OR FAX THEM TO (760)252-6754.

GENERAL INFORMATION:

Name:
                 Last                                                                        First                                                                                                 MI
Social Security #: Phone #:
Email:

Address:
            Street                                     City                     State and Zip Code

Date of Birth: Marital Status: Single MarriedDivorcedSeparatedWidowed

Has the admissions and records department determined that you are a California Resident? Yes No
Note: Students who are exempted from paying nonresident tuition under Education Code Section 68130.5 (AB 540) are not California residents.   If you are not a California resident you are not eligible for this fee waiver. Do not complete this application. You can still file the FAFSA to be evaluated for other aid. Please get a FAFSA and complete it.
IMPLEMENTATION OF THE CALIFORNIA DOMESTIC PARTNER RIGHTS AND RESPONSIBILITIES ACT
Recent legislation (Assembly Bill 205) extends new rights, benefits, responsibilities and obligations to individuals in domestic partnership registered with California Secretary of State under Section 297 of the Family Code. If you are in a Registered Domestic Partner (RDP), you will be treated as an independent married student to determine eligibility for this 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.
**These new provisions apply to state funded student financial aid ONLY, and not for federal student financial aid.

Are you or your parent in a Registered Domestic Partnership with the California Secretary under Section 297 of the Family Code? (Answer “Yes” if you or your parent are separated from a RDP but have NOT FILED a Notice of termination of Domestic Partnership with the California Secretary of State’s Office.) □ Yes □ No

If you answered “Yes” to the question above treat the Registered Domestic Partner as a spouse. You are required to include your domestic partner’s income and household information or our parent’s income and household information in Questions 3, 6, 7, 8, 9, 10, 11, 12.

Student Marital Status: Single Married Divorced Separated Widowed Registered Domestic Partnership

DEPENDENCY STATUS:

1. Were you born before January 1, 1982? Yes No
2. As of today , are you married or in a Registered Domestic Partnership? Yes No (answer yes, if you are separated but not divorced or have not filed a termination notice to dissolve partnership.)
 3. Do you have children who receive more than half of their support from you or other dependents who live with you (other than your children an spouse)  who receive more than half of their support from you, now and through June 30, 2006? Yes No
4. Are you an orphan or a ward of the court, or were you a ward of the court until your 18th birthday? YesNo
5. Are you a veteran of the U.S. Armed Forces? Yes No

If you answered "Yes" to any of the questions 1-5 you are considered an INDEPENDENT student and must provide income and household information about yourself (and your spouse if you are married). Skip to Question #8.

If you answered "No" to all questions 1-5, complete the following questions:

6. If your parent(s) filed or will file a 2004 U.S. Income Tax Return, were you , or will you be claimed on their tax return as an exemption by either or both of your parents?
Yes No Parent(s) won't file
7. Do you live with one or both of your parent(s) and/or his/her RDP?  Yes No

*If you answered "No" to questions 1 through 5, and "Yes" to either question 6 or 7, you must provide income and household information about your PARENT(S).  Please answer questions for a DEPENDENT student in the sections that follow.  Skip to question #8.

If you answered "no" or "Parent(s) won't file" to question 6 and "no" to question 7, you are a dependent student for all student aid except this fee form waiver.  You may answer questions as in INDEPENDENT student on the rest of this application, but please try to get your PARENT information and file a FAFSA so you may be considered for other student aid.  You cannot get other student aid without your parent(s) information.  Talk to the Financial Aid staff if you think you have special circumstances. Skip to question #8.
SPECIAL CLASSIFICATIONS
METHOD A

8. Are you (the student ONLY) currently receiving monthly cash assistance from:

TANF/CalWORKs? Yes No
SSI/SSP (Supplemental Security Income/State Supplemental Program)? Yes No
General Assistance?YesNo

9. If you are a dependant student, are your parent(s)/RDP receiving monthly cash assistance from TANF/CalWORKs or SSI/SSP as a primary source of income? Yes No

● If you answered "Yes" to question 8 or 9 you are eligible for a FEE WAIVER. Sign the Certification at the end of this form. You are required to show proof of benefits. Ask the Financial Aid Office for the FAFSA to be eligible for other financial aid opportunities.
 

METHOD B

10. DEPENDENT STUDENT: How many persons are in your parent(s)' household? (Always include yourself, your parent(s), and anyone who lives with your parent(s) and receives more than 50% of their support from your parents, now and through June 30, 2006.)

11. INDEPENDENT STUDENT: How many persons are in your household? (Include yourself, your spouse, and anyone who lives with you and receives more than 50% of their support from you, now through June 30, 2006.)

2004 Income Information: DEPENDENT STUDENT:
PARENT(S) INCOME		 INDEPENDENT STUDENT:
STUDENT (AND SPOUSE) INCOME
12A. Adjusted Gross Income
(If 2004 U.S. Income Tax Return was filed, enter the amount from Form 1040, Line 34; Form 1040A, Line 21; or Form 104OEZ, Line 4 or Telefile, Line 1.) 		$ $
12B. All other Income (Include ALL money received in 2004 that is not included in line [A] above) $ $
Total Income for 2004 (Sum of a + b). $ $
The Financial Aid Office will review your income and let you know if you qualify for an automatic FEE WAIVER.  Even if you do not qualify using this simple method, you should file a FAFSA.  Many, many students do not qualify under Method A or B but still qualify for a FEE WAIVER and MORE FINANCIAL AID by filing the FAFSA.  The Financial Aid Office will give you forms and information.
Special Classifications

NOTE: Eligibility for the following Special Classifications will only waive the Enrollment Fee. To be eligible to have the Parking Fee reduction and/or the Health Fee waived requires the completion of the BOGFW or FAFSA applications.

13. Do you have certification from the California Department of Veterans Affairs or the National Guard Adjutant General that you are eligible for a dependent's fee waiver? Submit Certification. Yes No

14. Are you eligible as a recipient of the Congressional Medal of Honor or as a child of a recipient, or a dependent of a victim of the September 11, 2001 terrorist attack? Submit documentation from the Department of Veterans Affairs or the CA Victim Compensation and Government Claims Board. Yes No

15. Are you eligible as a dependent of a deceased law enforcement/fire suppression personnel killed in the line of duty? Submit documentation from the public agency employer of record and income information. Yes No

If you answered "yes" to question 13 or 14 or 15, you are eligible for a FEE WAIVER.  Sign the Certification at the end of this form. 

 

STOP!  Now print this form, sign it and either mail or fax it to the college.  MAIL THE FORMS TO FINANCIAL AID, 2700 BARSTOW ROAD, BARSTOW, CA 92311 OR FAX THEM TO (760)252-6754. CERTIFICATION FOR ALL APPLICANTS: READ THIS STATEMENT AND SIGN BELOW

ALL APPLICANTS: READ THIS STATEMENT AND SIGN YOUR NAME BELOW. IF YOU ARE APPLYING FOR A FEE WAIVER YOU WILL HAVE TO PRINT THIS APPLICATION, FILL IT OUT AND SEND IT TO BARSTOW COLLEGE VIA MAIL OR FAX.  MAIL THE FORMS TO FINANCIAL AID, 2700 BARSTOW ROAD, BARSTOW, CA 92311 OR FAX THEM TO (760)252-6754.

I hereby swear or affirm, under penalty of perjury, that all information on this form is true and complete to the best of my knowledge. If asked by an authorized official, I agree to give proof, which may include a copy of  my and my spouse/registered domestic partner and/or my parent's/registered domestic partner's  2004 U.S. Income Tax Return(s). I also realize that any false statement or failure to give proof when asked may be cause for the denial, reduction, withdrawal, and/or repayment of my waiver. I authorize release of information regarding this application between the college, the college district, and the Chancellor's Office of the California Community Colleges.

___________________________________
Applicant's signature                                 Date


______________________________________
Parent's Signature                                                        Date
(Dependent Students Only)                                        

This application will  only waive your fees.  Please file an application for additional student aid.  To see if you qualify for more aid, complete a FAFSA.  The FAFSA is available at the Financial Aid Office or at http://www.fafsa.ed.gov.

 FOR OFFICE USE ONLY
Do not fill out anything below here.

Check one of the following:

BOGFW-A:
TANF/CalWORKs
GA
SSI/SSP
 Special Classification
VET/NG DEP
 MEDAL of HONOR/ or
     9/11 DEPENDENT
 Dep. of deceased law enforcement personnel
BOGFW-B
BOGFW-C
RDP Student
 RDP Parent
Student is not eligible

Notes:________________________________________________________

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CERTIFIED BY: DATE:

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