UHS Reduced Program FeeVerification Request Form

UHS Reduced Program Fee Verification Request Form
UHS offers a reduction in the UHS Program Fee for students who are eligible for the Federal Reduced/Free Lunch Program. In order for us to verify your eligibility for this reduced rate, please complete this form and provide your school's Guidance Counselor / Principal information below.

Forms with the incorrect or incomplete information will not be processed.

You will receive a confirmation email once your school has processed your request.
- If you are deemed eligible you will receive a promotional code via email to allow you to register for your course at a reduced rate.
- If you are deemed ineligible, you will receive an email informing you that you will need to submit your registration at the full rate.
UHS Academic Year
SECTION A. To be completed by student
Student Name*

First NameLast Name
Student Phone Number*
Please enter a valid phone number.
Student Personal Email*
example@personal.com
High School Name*
High School Guidance Counselor or Principal Name *

First NameLast Name
High School Guidance Counselor or Principal Email*
Check for accuracy!
High School Official Title*
Guidance Counselor, Principal, Dean
NOTE: Please double check that you have entered all email addresses correctly. If the email is entered incorrectly, the form will not be processed.

If you do not know your school's Guidance Counselor or Principal information, please check with your High School prior to submitting this form.
Once you submit Section A of this form, your High School Guidance Counselor or Principal will receive an email to complete Section B. Please note that it is your responsibility to follow up with your Guidance Counselor or Principal to make sure they receive and complete Part B of this form. In order for this request to be processed, both sections must be completed.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
Student Signature*
Student Signature Date*

MonthDayYear
Date
Please verify that you are human*

UHS Reduced Program Fee Verification Request Form
UHS offers a reduction in the UHS Program Fee for students who are eligible for the Federal Reduced/Free Lunch Program. In order for us to verify your eligibility for this reduced rate, please complete this form and provide your school's Principal or Guidance Counselor information below.

Forms with the incorrect or incomplete information will not be processed.

You will receive a confirmation email once your school has processed your request.

If you are deemed eligible you will receive a promotional code via email to allow you to register for your course at a reduced rate.
If you are deemed ineligible, you will receive an email informing you that you will need to submit your registration at the full rate.
UHS Academic Year
SECTION A. To be completed by student
Student Name

First NameLast Name
Student Phone Number
Please enter a valid phone number.
Student Personal Email
example@personal.com
High School Name
High School Guidance Counselor or Principal Name

First NameLast Name
High School Guidance Counselor or Principal Email
Check for accuracy!
High School Official Title
Guidance Counselor, Principal, Dean
NOTE: Please double check that you have entered all email addresses correctly. If the email is entered incorrectly, the form will not be processed.

If you do not know your school's Guidance Counselor or Principal information, please check with your High School prior to submitting this form.
Once you submit Section A of this form, your High School Guidance Counselor or Principal will receive an email to complete Section B. Please note that it is your responsibility to follow up with your Guidance Counselor or Principal to make sure they receive and complete Part B of this form. In order for this request to be processed, both sections must be completed.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
Student Signature
Student Signature Date

MonthDayYear
Date
SECTION B. To be completed by High School Guidance Counselor or Principal

Note: this section is ONLY to be completed by the High School Guidance Counselor or Principal
High School Name*
High School Guidance Counselor or Principal Name*

First NameLast Name
High School Guidance Counselor or Principal Email*
example@example.com
High School Official Title*
Guidance Counselor, Principal, Dean
Please certify that your High School records indicate that the student listed above either is participating or is eligible to participate in the Federal Reduced/Free Lunch Program
Verification Decision*

EligibleNot Eligible
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
High School Guidance Counselor or Principal Signature*
High School Signature Date*

MonthDayYear
Date
Should be Empty:

UHS Reduced Program Fee Verification Request Form

SECTION A. To be completed by student

UHS Reduced Program Fee Verification Request Form

SECTION A. To be completed by student

SECTION B. To be completed by High School Guidance Counselor or Principal