SENIOR CITIZENS STUDENT TUITION ASSISTANCE

Christanna CampusJohn H. Daniel Campus

109 Campus Drive200 Daniel Road

Alberta, VA 23821Keysville, VA23947

Telephone: (434) 949-1000Telephone: (434) 736-2000

Name:______Phone:______

Student ID #______Date of Birth ______

APPLICANT NOTE:Please read the guidelines for eligibility on the back of this form before completing further. Must attach an enrollment form to this waiver.

CHECK ONE:

______A.I hereby certify that I am qualified for free tuition for credit courses under the Senior Citizens Higher Education Act.

______B.I hereby certify that I am qualified for free tuition for audit of credit courses or for taking non-credit courses under the Senior Citizens Higher Education Act.

Signature:______Date:______

OFFICE USE ONLY...DO NOT WRITE BELOW THISLINE

COURSE TITLE / CREDIT/AUDIT/NON-CREDIT

Student is responsible for any special fees and books. Student is not eligible for Financial Aid and Senior Citizen Waiver.

Admissions:______Class space available: YES______NO______

Approval:

V.P. for Academics and Student Affairs:______

Date: ______

GUIDELINES FOR ELIGIBILITY

“SENIOR CITIZENS HIGHER EDUCATION ACT OF 1974"

1. To be eligible for free tuition and fees for credit courses, part-time or full- time, a person must meet the following criteria:

  1. Be 60 years of age or older.
  2. Be legally domiciled in Virginia.
  3. Have a taxable income not exceeding $15,000 for Federal Income Tax purposes for the year preceding the year in which enrollment is sought.
  4. Be admitted to the College as a student.
  5. Submit previous year Federal Tax return.
  1. To be eligible for free tuition for audit of credit courses or for taking non- credit courses, a person must meet the following criteria:
  1. Be 60 years of age or older.
  2. Be legally domiciled in Virginia.
  3. Be admitted to the College as a student.

II.

1. In order to offer either of the above to Senior Citizens, the College must allow all tuition paying students first priority for class space. Non-paying Senior Citizens may not be counted in this total.

  1. Also, Senior Citizens may be registered for a class under either of the above guidelines only after all tuition-paying students have registered. If a class becomes filled to capacity with tuition-paying students, the College will be unable to offer either option to Senior Citizens.

PLEASE COMPLETE THIS FORM AND RETURN TO THE APPROPRIATE OFFICE.

SOUTHSIDEVIRGINIACOMMUNITY COLLEGE

Christanna CampusJohn H. Daniel Campus

109 Campus Drive200 Daniel Road

Alberta, VA 23821Keysville, VA23947

Telephone: (434) 949-1000Telephone: (434) 736-2000

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