Office of Employee Engagement Approval ___
Revised May 2019
APPLICATION FOR DAEMEN COLLEGE TUITION WAIVER
EMPLOYEE Name Social Security Number _XXX-XX-_______ _
STUDENT Name _______
Social Security Number XXX-XX-__________ Date of Birth
School Attending____________
Anticipated Graduation Date
Course Level
Undergraduate Graduate (Dependent benefits are taxable; see Employee Handbook)
Student Status
FULL-TIME PART-TIME
Relationship to Employee
Self Spouse Dependent Child as classified by IRS
I am applying for the Tuition Waiver benefit for the following semester(s):
Full Academic Year 20____-____
Summer 20____ ~ (Circle One) Session 1 Session 2 Session 3
Fall 20____
Intersession/Spring 20_____
I understand that the Tuition Waiver Benefit ceases upon termination of employment or if employment is no
longer full time benefit eligible. If the student is attending Full Time, then I agree to have the student apply
for the New York State Tuition Assistance Program (TAP) Award. Tuition benefits are contingent upon
acceptance to the enrolled College and the student continued to show academic progress. For dependent
children, Daemen may request documentation to certify dependent status as classified by the IRS. All
pertinent Daemen Policies and IRS tax laws apply.
____________________
EMPLOYEE SIGNATURE DATE
*College reserves the right to cancel summer classes with insufficient number of paying students
are enrolled.
