COLORADO SCHOOL OF MINES
TUITION CLASSIFICATION CERTIFICATION
ACTIVE DUTY MILITARY IN COLORADO
PLEASE PRINT
TERM & YEAR
STUDENT STATUS:
GRADUATE
UNDERGRADUATE
STUDENT NAME
EX-MINES
NON-DEGREE

CSM CWID#
If the student is a military dependent, please complete the following:
Name of U.S. Armed Forces Member
Social Security Number
CERTIFICATION BY BASE EDUCATION SERVICES OFFICER
The certification below must be completed, signed by certifying official (Base Education Services Officer), and
submitted to the Registrar's Office no later than the first day of class of each term for which the student meets
the requirement of the exemption for resident tuition classification.
First Undergraduate Term:
Admissions Office - Student Center
First Graduate Term:
Graduate School - Guggenheim Hall, Third Floor
All other students:
Registrar's Office - Student Center
I certify
is an ACTIVE duty member of the U. S. Armed Forces
and has a permanent duty station in Colorado at (military installation)
. For
dependents only: Student
is a legal dependent of this armed forces
member.
I further attest the information certified above will remain in effect as of (first day of classes)
for the
term and year
at the Colorado School of Mines.
Signature of Certifying Official
Office or Command
Printed Name and Title
Date
STUDENT CERTIFICATION
I understand and agree to the following conditions:
1.
This certification form must be completed each term in which I enroll.
2.
This completed form must be submitted to the appropriate office at Colorado School of Mines by
the first day of class for the term. It may not be honored if submitted after that date.
3.
Failure to submit this form by the deadline may result in non-resident tuition assessment without
right of appeal.
Student Signature
Date