Readmit Application Fee Waiver Request Form

Readmit applicants to SUNY Plattsburgh who are U.S. Citizens or Permanent Residents, and wish to be considered for a readmit application fee waiver, must submit the following (in addition to this form):

1. A letter requesting a fee waiver along with proof that you meet the income requirements shown in the table below.

2. A copy of your most recent signed Federal Tax Return including all business schedules (if applicable) AND W2 from employer(s); OR, proof that you receive Social Service Benefits, Social Security or SSI, unemployment benefits, etc.

-OR-

3. If you have an extenuating circumstances* and do not feel that you have the ability to pay the readmit application fee.
*You must provide a written statement, addressed to the Director of Admissions, describing the extenuating circumstance for which you are requesting a readmit application fee waiver. The "Applicant Section" must be completed to be considered.

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Financial eligibility is primarily determined by the family income guidelines shown in the table below. These are the same guidelines as those used by the SUNY system.

Household Size: 1 Annual Income: $23,828
Household Size: 2 Annual Income: $32,227
Household Size: 3 Annual Income: $40,626
Household Size: 4 Annual Income: $49,025
Household Size: 5 Annual Income: $57,424
Household Size: 6 Annual Income: $65,823
Household Size: 7 Annual Income: $74,222
Household Size: 8 Annual Income: $82,621

*Plus, 8399 for each family member in excess of eight.

Applicant Section

First Name

Last Name

Date of Birth

Banner ID or Net ID

Country

Street

City

Region

Postal Code

Phone

Number of dependents in household (including head of household):

Total income before taxes (all sources):

My signature below confirms that the information I have provided is accurate. I understand that if my fee is not waived, I am responsible to pay the fee before my application will be reviewed for readmission. The documentation in support of this fee waiver is included along with this form

Signature of Head of Household (if different):

Date

I understand this is a legal representation of my signature.