Graduate Application for Admission

Diversity Program Participation

Fee Waiver Verification Form
Applicant Instructions:
1) Confirm participation in an eligible program:
http://gradfeewaiver.stanford.edu#Program
2) Complete the Applicant Information and Program Director Information sections
3) Obtain the signature of the Program Director
4) Uploaded a scan (PDF or JPG) of the signed form as part of the fee waiver application
(forms without a signature will not be accepted)

Eligible Program Information

Program Name

(drop down menu):

Amgen Scholars Program

Most recent academic year of program participation/funding:

Applicant Information
Full Name:

Stanford Department Applied to:

Email address:
Phone Number:

Undergraduate Institution:

Program Director Information

Name:
Title:

Institution:
Email:

Phone Number:

Program Director Signature

I verify that I am an authorized representative of the program indicated
above and that the applicant, ____________________________________, is (or was
at the time of graduation)
(print applicant name)

a participant of the program in good standing.

Signature: ____________________________________________________
______________

Date:

08/20/14