UIC Orientation

Summer 2008

Please use this form to request a 50% discount for the UIC Orientation fee. This form, along with documentation verifying the above information, must be faxed, mailed or delivered to the Orientation Program at least seven days prior to your orientation date. Requests submitted outside this timeline will be declined.

 _________________________________________________________________________

 Student Name (Printed)                                     University ID or Applicant Number

Completed by Student:

The family has extreme financial difficulty as identified through one or more of the following indicators.  Please check one and provide a photocopy of documents for verification.

§  ­Family receives public assistance

§   Free Federal Lunch Program participant (not reduced)

§   Family contribution towards the student’s college education is $0 

     Please submit a copy of your UIC financial aid award letter

§   Illinois Veteran Grant recipient

§  Other.  Please explain on separate sheet

Please read the following information and sign to acknowledge that you understand the discount request form process.

All of the information put forth on my Orientation Fee Discount Request form is accurate and complete to the best of my knowledge. Additionally, I understand that all supporting documentation must be received by the Orientation Program at least seven days prior to my scheduled orientation date otherwise; the form will not be valid. I also understand that this form makes me eligible for a 50% orientation fee discount, not necessarily a full refund.

Signature ____________________________________________________________________

Date   _______________________________________________________________________

Completed by Administrator:

I have verified that this student qualifies for the reason(s) indicated above.

Name _______________________________________________________________________

Title    _______________________________________________________________________

____________________________________________________________________________

Signature                                                          Date

_____________________________________________________________________________

School, Agency, or Institution

_____________________________________________________________________________

Telephone 

Do Not Write Below This Line

_____________________________________________________________________________

Decision           p Approved     p Denied

Signature ____________________________________________________________________

Date _________________________         Date Received _____________________________