Application Fee Waiver Request University of Wisconsin System

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					                                         Application Fee Waiver Request
                     University of Wisconsin System Undergraduate Application for Admission
Each undergraduate application submitted to a University of Wisconsin System university requires a $44 application fee.
A limited number of application fee waivers are available for applicants with extreme financial hardship. To request a waiver
of the application fee, complete this form and submit it to the Office of Admissions at the university/universities to which
you are applying. Your request will be reviewed and a determination will be made regarding waiver of the fee.

 APPLICANT (To be completed by the individual applying for admission.)

Applicant Name: First ________________________ Middle Initial ____ Last (Family) ____________________________

Street Address: ______________________________                City/State/Zip Code: ___________________________________

Area Code & Phone Number: ___________________                 Email Address: ________________________________________

Date of Birth (Month/Day/Year): ________________

Please state the reasons you are requesting a waiver:




I certify that the information in this form is true and correct to the best of my knowledge, and that payment of the
application fee would pose a financial hardship. I authorize the Financial Aid Office to release information relating to
my financial need to the Office of Admissions if requested.

Signature of Applicant: ___________________________________________________________ Date: ______________

Signature of Parent/Guardian (if applicant is under age 18): ______________________________ Date: ______________

  VERIFYING OFFICIAL (To be completed by a school or agency official who can verify financial hardship. If you are in high
school, ask your counselor or principal to complete the information below. If you have graduated from high school, ask
an agency or university official to complete the information.)

Name of Official: _______________________________ Title: ________________________________________________

Name of School/Agency/Educational Institution: ___________________________________________________________

Area Code & Phone Number: _____________________ Email Address: ________________________________________

Please state your knowledge of the financial need of the applicant. (Examples of financial hardship may include, but
not be limited to, unemployment (of parent/guardian if dependent, or of self if independent); participation in a free or
reduced lunch program; and/or low income in relation to family size.):




Signature of Verifying Official: ____________________________________________________ Date: ________________

FOR OFFICE USE ONLY
Admissions Official: _________________________                Date: ________             ❑ Waiver Granted ❑ Waiver Denied

Comments:
UW-Eau Claire                          UW-Green Bay                  UW-La Crosse
P.O. Box 4004                          2420 Nicolet Drive            1725 State Street
Eau Claire, WI 54702-4004              Green Bay, WI 54311-7001      La Crosse, WI 54601-3788
(715) 836-5415                         (920) 465-2111                (608) 785-8939
admissions@uwec.edu                    uwgb@uwgb.edu                 admissions@uwlax.edu

UW-Madison                             UW-Milwaukee                  UW-Oshkosh
Office of Admissions and Recruitment   P.O. Box 749                  P.O. Box 2423
702 West Johnson Street, Suite 1101    Milwaukee, WI 53201-0749      Oshkosh, WI 54903-2423
Madison, WI 53715-1007                 (414) 229-3800                (920) 424-3164
(608) 262-3961                         uwmlook@uwm.edu               admissions@uwosh.edu
onwisconsin@admissions.wisc.edu

UW-Parkside                                                          UW-River Falls
P.O. Box 2000                          1 University Plaza            410 S. 3rd Street
Kenosha, WI 53141-2000                                               River Falls, WI 54022-5001
(262) 595-2355                         (608) 342-1125                (715) 425-3500
admissions@uwp.edu                                                   admit@uwrf.edu

UW-Stevens Point                       UW-Stout                      UW-Superior
1108 Fremont Street                    124 Bowman Hall               P.O. Box 2000
Stevens Point, WI 54481-3897           Menomonie, WI 54751-0790      Belknap & Catlin
(715) 346-2441                         (715) 232-1232                Superior, WI 54880-4500
admiss@uwsp.edu                        admissions@uwstout.edu        (715) 394-8230
                                                                     admissions@uwsuper.edu
UW-Whitewater
800 W. Main Street
Whitewater, WI 53190-1791
(262) 472-1440
uwwadmit@uww.edu



Freshman/Sophomore Colleges
UW-Baraboo/Sauk County                 UW-Barron County              UW-Fond du Lac
1006 Connie Road                       1800 College Drive            400 University Drive
Baraboo, WI 53913-1098                 Rice Lake, WI 54868-2497      Fond du Lac, WI 54935-2998
(608) 355-5230                         (715) 234-8024                (920) 929-3606
boouinfo@uwc.edu                       uwbcinfo@uwc.edu              fdlinfo@uwc.edu

UW-Fox Valley                          UW-Manitowoc                  UW-Marathon County
1478 Midway Road                       705 Viebahn Street            518 S. 7th Avenue
Menasha, WI 54952-1224                 Manitowoc, WI 54220-6699      Wausau, WI 54401-5396
(920) 832-2620                         (920) 683-4707                (715) 261-6241
foxinfo@uwc.edu                        manadmit@uwc.edu              uwmc@uwc.edu

                                                                     UW-Richland
750 W. Bay Shore Street                2000 W. 5th Street            1200 Highway 14 West
                                                                     Richland Center, WI 53581-1399
(715) 735-4301                         (715) 389-6500                (608) 647-8422
ssinfo@uwc.edu                         msfadmit@uwc.edu              rlninfo@uwc.edu

UW-Rock County                         UW-Sheboygan                  UW-Washington County
2909 Kellogg Avenue                    One University Drive          400 University Drive
Janesville, WI 53546-5699              Sheboygan, WI 53081-4789      West Bend, WI 53095-3699
(608) 758-6523                         (920) 459-6633                (262) 335-5201
rckinfo@uwc.edu                        uwshb@uwc.edu                 uwwcss@uwc.edu

UW-Waukesha                            UW Colleges Online
1500 N. University Drive               505 S. Rosa Road, Suite 200
Waukesha, WI 53188-2799                Madison, WI 53719-1277
(262) 521-5040                         (877) 449-1877
wakadmit@uwc.edu                       academicadvisor@uwc.edu