2020-2021 Tuition Assistance Application
Please fill in information completely to avoid delay in processing your application and then submit to the Employee
Benefits Office, Human Resources. Questions? Please call 269.471.3886 or email benefits@andrews.edu.
EMPLOYEE’S INFORMATION:
Employee’s Name _________________________________________ AU ID# ___________________
Department _________________________________________
Spouse’s Name __________________________________________AU ID# (if any) ______________
Occupation __________________________________________
Employer __________________________________________
Address/Telephone __________________________________________
DEPENDENT’S INFORMATION:
Full Name AU ID Date of Birth Name of School Grade/College Dormitory
of Dependent(s) (if any) mm/dd/yy Attending in 2020-2021 Level or Commute
___________________ _______ ________ __________________ _________________ ____________
___________________ _______ ________ __________________ _________________ ____________
___________________ _______ ________ __________________ _________________ ____________
___________________ _______ ________ __________________ _________________ ____________
I, ____________________________ have read and understand the tuition assistance policy implemented by Andrews
University. I request my organization to remit, on my behalf, assistance for my dependent(s).
Employee’s Signature _____________________________ Date: ______________
FOR ANDREWS UNIVERSITY EMPLOYEE BENEFITS OFFICE USE:
Financial assistance for the above-referenced employee’s dependent(s) is/are hereby approved. Education subsidy will
be sent directly to:
Dependent(s) Dependent(s) Tuition Assistance %
Andrews University ___________________ ______________________ _________
Andrews Academy ___________________ ______________________ _________
Ruth Murdoch ___________________ ______________________ _________
Elementary School
Griggs International Academy ___________________ ______________________ _________
See here for additional info: GIA Handbook
Other______________ ___________________ ______________________ _________
Starting Date of Tuition Assistance ___________________
Authorized by ______________________________ Date: __________________
Employee → Employee Benefits Office→ Student Financial Records (Non-Denominational spousal employer AU students
only), Financial Records (All Others), Benefits (files)
A B C
