ASSOCIATED COLLEGES OF THE SOUTH
TUITION EXCHANGE PROGRAM
Certification Form

I. TO BE COMPLETED BY EXPORTING INSTITUTION

Student Information:

Name: ________________________________ Social Security #_______________
Home address ______________________________________________________
__________________________________________________________________

Institution to which application is being made: _______________________________
_________________________________________________________________

Employee Information:

Name: ____________________________________________________________
Employee's Institution_________________________________________________
Employee's Position __________________________________________________
Relation of Student to Employee_________________________________________

The applicant student is a dependent child of a full-time faculty or staff member who
is eligible for benefits under the employing institution's tuition exchange program.

Signed ____________________________ Date ___________________________
Title ______________________________

(Forward to ACS Tuition Exchange Coordinator at Importing Institution and ACS)

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II. TO BE COMPLETED BY IMPORTING INSTITUTION

Student Eligibility:

________Approved for Tuition Exchange for Academic Year 20 ____ - 20 ____
Classified as: ______ freshman ______ sophomore ______ junior ______senior

________Declined for Tuition Exchange for Academic Year 20 ____ - 20 ____
________Approved for Admission
________Declined for Admission

Signed________________________________________Date__________________
Title________________________________________

(Forward to ACS Tuition Exchange Coordinator at Exporting Institution and ACS)