GO RIO U-Pass Transit Fee Waiver Form Semester*Select...SpringFallYear*Year..2022202320242025Name* First Middle Initial Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Student I.D.* Select all that apply* 100% Online 100% Continuing Ed 100% Police/Fire Academy Training Cadets DREAMER BOGFW CalWORKs Veteran or dependents of veterans Please attach proof of waiver eligibility* Drop files here or Select files Accepted file types: jpg, pdf, png, Max. file size: 5 MB, Max. files: 1. I am aware of the services provided by the GO RÍO transit fee. I choose to receive a waiver of the $9.00 GO RÍO transit fee. Furthermore, I acknowledge that receipt of this waiver makes me ineligible to receive the GO RÍO pass within the semester I am claiming the waiver. Signature*Date* MM slash DD slash YYYY
