Fairfield University Application for FACHEX or Tuition Exchange Program

Please complete the form below and return to Kelley Center (Laura Martin) no later than September 5, 2008 if applying only for the Tuition Exchange program. FACHEX applicants have until December 1, 2008 to submit this form.

Parent Employee:

Name _________________________________________
Campus address _________________
Campus phone __________________

Date employed ____________
Department ______________
Full-time:  Yes (  ) No (  )

Position/Title ____________________________
E-mail address _______________________

Signature ________________________________
Date _______________

Select the program you are applying for:    
FACHEX         ______
T. Exchange   ______
BOTH            ______

Student Applicant Information:

Name ___________________________________
SSN ______ - _______ - ________

Address __________________________________
Telephone _________________________
E-mail address ______________________________

List the FACHEX and/or Tuition Exchange colleges or universities to which your child plans to apply.  You may add to this list at any time by notifying Laura Martin (ext. 2347).

 1. ______________________________________
 2. ______________________________________
 3. ______________________________________
 4. ______________________________________
 5. ______________________________________
 6. ______________________________________
 7. ______________________________________
 8. ______________________________________
 9. ______________________________________
10. _____________________________________

To be eligible, your SON/DAUGHTER will need to be a full time freshman at the beginning of the next academic year (Fall 2009).

4/2008