Membership Dues Waiver Request - Hardship

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Membership Dues Waiver Request

If paying membership dues represents an extreme economic hardship for you, LSA may agree to waive your membership dues. Please fill out the form below to request a dues waiver.

Full name*

First name
Last name

2.	Email address*

3.	Phone number*

4.	I want to...*

5.	I am currently a linguistic student at undergraduate/graduate level and have not completed my degree. *

6.	I request a membership fee waiver for the current year on the following grounds:* Please select the option that best describes your situation.
	Paying the regular membership fee would constitute an extreme financial hardship. See note 1 below.
	I am a scholar in a country in which the LSA membership fee constitutes an out-of-reach cost.

Note 1: Extreme economic hardship

Extreme economic hardship includes, but is not limited to, the following:

Currently qualifying for food stamps, temporary assistance to needy families, unemployment benefits, Medicaid, or other federal financial assistance based on economic need.
Currently qualifying for a federal Pell grant or other student grant program based on economic need. Note: student loans are not grants.
Currently qualifying for local, state or other financial assistance programs administered by a government agency or private charity.

With my signature below, I affirm that the above statement is accurate and true. I understand that misrepresentations on this form may result in a loss of the waiver and other such membership privileges as appropriate.

7.	Signature* Type your full legal name.

8.	Today's date*
	mm/dd/yyyy