Dependent Of Military Personnel, Police Officer, Or Firefighter Waiver Request (A)

Submission ID
DEPENDENT OF MILITARY PERSONNEL, POLICE OFFICER, OR FIREFIGHTER WAIVER REQUEST
Accessibility Statement

Delgado Community College is committed to digital accessibility. This form is designed to be compatible with assistive technologies and follow accessibility standards. If you encounter any barriers or need an alternative format to provide your signature, please contact us by emailing the Bursar's Office at bursaroffice@dcc.edu.
Provides educational assistance in state-supported colleges and universities for children of certain deceased war veterans, police officers, and firefighters.

Students receiving this exemption must be in good Academic Standing as defined by Delgado Community College and must be enrolled full time through Census day.

Eligible students will receive a Fee Exemption Certificate from the Louisiana Department of Veteran Affairs. You must submit the original certificate (or approved digital copy) to receive the waiver.
STUDENT REQUEST INFORMATION
Student Name (First Last):*
Student LoLA ID:*
L00000000
Student Email:*

Confirmation Emailexample@dcc.edu
Semester:
Waiver Type:*
To be completed by Student Account Representative
Processed By:
Employee Name
Official Certificate:
Academic Requirement:
Status:
Balance Due
Comments/Requirements:
Status Date:

MonthDayYear
Expiration Date:*
WAIVER CERTIFICATE*

Cancelof
Additional Comments:
Optional
STUDENT AUTHORIZATION
Student Certification:*

I hereby certify that the attached EXEMPTION CERTIFICATE is a true and accurate copy of the original which I have in my possession.I acknowledge that I must be enrolled as a full-time student (12 or more credit hours) and be in good Academic Standing as defined by Delgado Community College.
Third Party FERPA Disclosure:*

I authorize Delgado Community College to release necessary financial and educational information, in the manner requested, to the State, Local, or Federal Agency for the purposes of certifying my eligibility.
Terms and Conditions:*

I understand that if it is later determined that I do not meet eligibility requirements, the waiver may be removed from my account and I will be required to pay the full amount due by the published or assigned due date(s).I promise to pay for all fees not covered by this waiver by the published or assigned due date(s). In the event the student becomes delinquent in paying charges or defaults in repaying charges, the debts may be transferred to the State of Louisiana Attorney General’s Office, the Louisiana Office of Debt Recovery, or another external agency for collection. All collection fees incurred shall be at the expense of the student which may be based on a percentage at a maximum of 33 1/3%. If Delgado prevails in a law suit to collect on the student’s financial obligation, the student will be responsible to pay Delgado’s court costs, collection fees and attorney’s fees in an amount the court finds to be reasonable.
Signature* Student: Please sign by clicking the signature line and signing this form.
Type Name*
*Once you enter your name you will not be able to make any changes to this request.
Date*

MonthDayYear
Please verify that you are human*
Should be Empty:

DEPENDENT OF MILITARY PERSONNEL, POLICE OFFICER, OR FIREFIGHTER WAIVER REQUEST

STUDENT REQUEST INFORMATION

To be completed by Student Account Representative

STUDENT AUTHORIZATION