What Cohort are you a part of? ( Please indicate HRD, CCTL, or HPE and the number): *

First Name: * Middle Initial:    

Last Name: *

Email: *

Describe the financial need that justifies your request for the waiver. *

Are you currently or have you received employee reimbursement or financial aid? Please explain. *

How many credit hours have you completed in your program? *

By electronically signing and submitting this form, I hereby attest that the information contained in this application is truthful. I understand any dishonesty and misleading statements on this application would violate the University of Illinois Code of Conduct and may lead to disciplinary action.

* I Agree I Disagree

Online Signature: *