Non-Resident Tuition Exception Form

Must complete ONCE

Name:*

First Name

Last Name

USM Student ID#: *

USM Email Address Requested: *

Semester: *

Admit Term:*

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Relationship (check one): *

Are you a Veteran or Service-Member?*

Is the sponsor you are using a Veteran or Service-Member? *

Name of Veteran/Service-Member: *

Branch of Service: *

Beginning Date of Service:*

Ending Date of Service:*

Type of Discharge (If Applicable): *

Proof of Service and/or Status: *Veteran/Service Member **

Copy of Valid Military ID Card Copy of DD-214 (member 4 copy) - Type of Discharge must be Honorable Copy of Active Duty Orders Other Documentation (As Required) Only for Dependents (You are not required to submit any documents from this section if you have provided a Valid Dependents Military ID Card.)

Proof of Service and/or Status Continued: **Dependents **

Copy of Valid Dependent Military ID Card Copy of Expired Dependent Military ID Card Copy of Dependent Birth Certificate or DEERS Printout Other Documentation (As Required) Only for Veteran/Services Members (You are not required to submit any documents from this section.)

*Veterans/Service Member must provide one of the above listed items as proof of service and/or status.

**Dependents must provide one item from the Veteran/Service Member list and one item from the Dependents list. (Only if not providing a Valid Copy of Dependent Military ID Card)

Attach The Appropriate Documentation At The Time Of Submission: *

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Date:*