Please complete the below form to submit your Activity and Wellness Fee Exemption request. NOTE: Once a student's Activity and Wellness Fee Exemption Form is approved, the student will NO LONGER be authorized to use any services which are financed with funds from the Activity and Wellness Fees. This includes use of the universities fitness centers and the Center of Health and Well-Being.
All fields are required unless otherwise noted.
Semester (Term and Year)
Please provide your specific circumstances that serve as justification for the exemption request: