(Do not use this form for Administrative Fee Waivers)

Fill out the following information and click 'Submit'.
* Indicates mandatory field.

*Student full name (from Application):
*Verify Email:
*Original or Amended form:
Original Amended
*Today's Date (click calendar icon):
*Waiver for: Other:  

In order to receive a waiver you must list the reason(s) for requesting it in the
following field; and, you must be able to furnish proof if it is requested by SLBC.

*Reason for request:
100 characters remaining.

By submitting this form I am affirming that the information on it is
true and accurate to the best of my knowledge.  And I also am
agreeing to the policy of the college that submission of
knowingly false information is grounds for my
dismissal from the college and loss of all
credits accrued and the marking of
my file as "Dismissed for
cheating or for submit-
ting knowingly false

*Agreement with SLBC policy:
Yes, I agree. No, I don't agree.