BATS Waiver Request Form :: Student Central Forms

Program You are Completing(Required)

Name(Required)

First Last

BC Email(Required)

Quarter:(Required)

Please select the quarter you are applying the WAIVER for.

Bellevue College Student Identification (SID) Number or ctcLink ID(Required)

I am requesting a waiver at this time for the $25 tuition for my ESL/ABE/HS+/GED® because I have at least one of the documents listed in the box below. I understand my name must be on the document and the document must be clear.

Hidden

Check all that apply; L & I does NOT apply(Required)

Working Connections ChildCare (WCCC) Award/Change letter
HUD Housing Award letter for public housing
Letter requesting waiver (on letterhead) from a church, community organization, Salvation Army, etc. The letter must address the student’s need re: low income

Check all that apply; L&I does NOT apply(Required)

Other:

Proof of waiver eligibility (Picture of Apple Health, WIC, copy of Quest benefits letter, etc...)(Required)

Your image or file must be clear, current, and have your name on it.

Max. file size: 5 MB.

Attendance Statement: Attendance is very important for your success. If you do not maintain regular attendance in your classes, you will NOT be eligible to receive a waiver when you register for the following quarter. I verify that the above information is correct and true.

Bellevue College does not discriminate on the basis of race, color, national origin, language, ethnicity, religion, sex, sexual orientation, including gender identity or expression, disability, or age in its programs and activities. Please see policy 4150 at www.bellevuecollege.edu/policies/. The following people have been designated to handle inquires non‐discrimination policies: Title IX Coordinator, 425.564.2641, Office C227, and EEOC/504 Compliance Officer, 425.564.2266, Office R‐130.

Student Electronic Signature(Required)

Include first name and last name upon agreement.

Date(Required)