Application for Out-of-State Tuition Exemption

Florida/West Africa Linkage Institute

Circle one: Mr. Ms. Mrs.

First Name : _______________________________ Middle Intial : ___________

Last Name : ________________________________

Social Security Number : _______________________________

Birthdate (Month Day Year) : ___________________

Mailing Address : ____________________________________________

City : _____________________ State (or Country) : __________________ ZipCode: _____________________

Email Address:_______________________________________________________

Phone : ______________________________

Current Grade Pt. Average : _____________

Citizenship : __________________________

Passport Number : __________________________ Visa Type : ___________________________________

Are you currently enrolled in a Public Institution in Florida? Circle one - Yes or No

If yes, which one? __________________________________ City : __________________________

If planning to transfer, where? ___________________________________

Academic Term/Year of Exemption: Circle one - Fall or Spring or Summer    Year : ________________

Enrollment in a : Circle one - credit program or non-credit

Major: _____________________________

Anticipated enrollment (*number of semester credit-hours)
(*Note: full time undergraduate = 12 hours/graduate = 9)

I AM or AM NOT currently receiving other scholarship aid : Circle one

If yes, please specify source and amount:

Source : ________________________________________ Amount : _______________________

I certify that the information given in this application is complete and accurate.



Signature : ___________________________________ Date : _____________________________

Out-of-state Tuition Waiver Checklist:

Be sure to include the following items in your application packet.

1. The completed application form.
2. Transcripts from all prior higher education institutions that you have attended.
3. Proof of acceptance or enrollment at a public Florida university or community college. (If you are a new student, a letter from the Director of Admissions will provide proof of acceptance. If you are currently enrolled, proof of registration will be needed.)
4. A one page essay telling us why you should receive a waiver.
5. Copy of your I20 as well as your passport information proving that you are a citizen of one of the 16 listed countries above.

Please mail or fox your application packet to ONE of the following institutions:

Mr. Oupa Seane, Executive Director
FLAWI
1 UNF Drive
Jacksonville, FL 32224
Fax: (904) 620-1790

Dr. Brenda Simmons, Director
FLAWI
Florida Community College at Jacksonville
4501 Capper Road C-102
Jacksonville, FL 32218
Fax: (904) 713-4853

Mrs. Agnes Coppin
FLAWI
Florida A&M University
302 North Perry Paige Building
Tallahassee, FL 32307
Fax: (850) 561-2587