Office of Admissions

275 Mount Carmel Avenue

Hamden, CT 06518-1908
Phone: 203-582-8600 or toll-free 800-462-1944
Fax: 203-582-8906
E-mail: admissions@quinnipiac.edu
www.quinnipiac.edu

Matriculation Fee Waiver Request Form

Student Name _______________________________________________________ QU ID ______________________________

Address__________________________________________________________________________________________________

City______________________________________________________________ State____________ Zip__________________

Country (if not U.S.)________________________________________________________________________________________

Phone Number_______________________________ E-mail ______________________________________________________

I plan to be a commuter _________; resident student __________

Due to financial hardship, I request that the following fee(s) be waived as I enter Quinnipiac University, as paying this fee
(these fees) would place an undue burden on me/my family (circle those that you wish):

$200 Matriculation Fee $150 Security Deposit $200 Housing Fee

I understand that I will be responsible for any assessed damages in the residence halls, and I will be responsible for any balance
due on my tuition/fees/room and board invoice.

To be granted a fee waiver, I understand that I should meet at least one of the following criteria:
• Pell eligible (FAFSA form must be on file with Quinnipiac)
• An international student with significant institutional aid and a statement of financial support

All students requesting a fee waiver must have identifiable means in place to cover all institutional charges.

Student Signature ________________________________________________________________ Date ___________________

Parent Signature__________________________________________________________________ Date ___________________

Please return your matriculation card and housing forms along with this form to the Bursar’s Office, Quinnipiac University,
275 Mount Carmel Avenue, Hamden, CT 06518-1908.
_________________________________________________________________________________________________________
Office Use Only

Waiver Approved: YES NO

Admissions Office Signature ________________________________________________________ Date ___________________