VIDEO COLLEGE APPLICATION FOR ADMINISTRATIVE/PRODUCTION FEE WAIVER

Please fill out the following information and click the submit button. "*" indicates mandatory fields.

ATTENTION: If you want a Waiver for the Administrative/Production fee
you need to establish financial hardship. Please include financial details below.

Thank you,
Dr. Van

*I verify that I am a registered student of the Video College (SLBCV).
Yes, I am a registered student of the Video College (SLBC).
*Your name exactly as it is on your Application form.
User Name (If you are registered with the SLBC Moodle site.)
(If you are not registered with the SLBC Moodle site, please leave the User Name field blank.)
*Country
Other:  
*Email
*Verify Email
Why do you need a Fee Waiver? (Include financial information but NOT names of financial institutions.)

1000 characters remaining.
*What Is Your Monthly Income in US Dollars?
*What is the amount of your Monthly Expenses in US Dollars?
*What Are Your Source(s) of Income? (separate multiple entries with comma and 1 space)
*I verify that all information is accurate to the best of my knowledge:
Yes, I verify that all information on this form is accurate to the best of my knowledge.