FLORIDA-CHINA LINKAGE INSTITUTE
  Application for Out-of-State Tuition Exemption
 The University of West Florida
 Brevard Community College

Please type or print clearly in ink.

SECTION I:  STUDENT INFORMATION

Mr.[ ] Ms.[ ] Last Name_____________________ First Name _______________ Visa Type_____SS#_______________

Mailing Address:________________________________________________________________________________________

City ______________________ State _______  Zip ___________ Telephone(s)_________________________________

Citizenship ________________  U.S. Permanent resident  Yes[ ] No[ ]  Passport No________________________

Are you currently enrolled in a Public Institution of Higher Education in Florida?  Yes [ ]   No [ ]

If not, in what term will you begin?  __________________________________________________________________

At what institution? _______________________________________________Have you been accepted? Yes[ ] No[ ]

SECTION II:  ACADEMIC PROGRAM:  CHECK APPROPRIATE CATEGORY
 

Undergraduate:	Lower Division	(L)	Freshman:	_______	Sophomore:	_______
	Upper Division	(U)	Junior:	_______	Senior:	_______
Graduate:		(G)	Master:	_______	Ph.D.:	_______

Please indicate how many out-of-state exemption hours you hope to receive at the graduate (G) or undergraduate (L) & (U) level for the academic year 2002-2003 (Fall & Spring) terms:
 

Fall 2002	_____ credits;	at the	_____ level.
Spring 2003	_____ credits;	at the	_____ level.

Have your ever received a tuition waiver from China Linkage Institute?  Yes [ ]  No [ ]

SECTION III:  STUDENT CERTIFICATION (Florida Statute 240.137)

Florida Statute 240.137 authorizes the exemption of out-of-state fees provided that the students receiving the exemption shall return to their home country for a period of time equal to the exemption period.  If granted this exemption, I agree to abide by this condition.
 

_____________________________________________________	____________________
STUDENT SIGNATURE	DATE