University Employee Tuition Waiver Form
Use this form to request tuition waiver consideration for eligible university coursework and route the request for review.
Employee Information
Employee Full Name
*
First Name
Middle Name
Last Name
University Email Address
*
example@example.com
Department
*
Job Title / Position
*
Employee ID or Alternate Employee Identifier
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Tuition Waiver Request Details
Term/Semester
*
Please Select
Fall
Winter
Spring
Summer
Other
Academic Year
*
Institution/Campus
Course Name
*
Course Code
*
Credit Hours
*
Course Start Date
*
-
Month
-
Day
Year
Date
Course End Date
*
-
Month
-
Day
Year
Date
Enrollment Status
*
Registered
Waitlisted
Not yet enrolled
Other
Reason/Justification for Request
Eligibility and Program Information
Degree or Certificate Program
*
School or College
*
Please Select
College of Arts and Sciences
College of Business
College of Education
College of Engineering
College of Health Sciences
Graduate School
Other
Is the course job-related?
*
Yes
No
Is the course part of a degree program?
*
Yes
No
Have you previously used tuition benefits for this term?
*
Yes
No
Remaining Tuition Waiver Eligibility Information
Prerequisite approvals received?
*
Yes
No
Approval and Acknowledgment
Approver Name
*
First Name
Middle Name
Last Name
Approver Email
*
example@example.com
Approval Status
*
Please Select
Approved
Needs Review
Rejected
Pending
Submit Request
Should be Empty: