Western University
Application for Educational Assistance
Please check your employee group’s collective agreement or policies to confirm eligibility.
Forward the completed form to Human Resources, SSB Room 4195 or email hrhelp@uwo.ca
Call 519-661-2194 (ext. 82194) for inquiries.
Services Needed (Please check one)
I have read and fully understood the terms and conditions of accepting Tuition Advance(s) printed on
the reverse side of this application.
Employee signature: ____________________________________
Date: ___________________________________________________
Name: __________________________________________________
Western ID # _____________________
(Department name and campus mailing address)
Student # ________________________
(if Western student)
Course title: _____________________________________________
Course # __________________________
This course is part of : Undergraduate Program
Graduate Program
Diploma (College)
Other ______________________________
Extension # _______________________
Educational institution: Western University
Brescia College
Kings College
Huron College
Other ____________________________
Amount requested:________________
(include only tuition fees)
Course duration: From ________________________, 20__ To _________________________, 20__
Check this option if you are planning
to take a course and want to know if
the course is covered under
Educational Assistance.
Please include:
Documentation describing the
course (syllabus, course content,
or similar).
Check this option if you are requesting
reimbursement for a COMPLETED
Please include:
Proof of payment (invoice for fees
and/or receipt).
Grade report and/or certificate of
attendance (if non-credit course).
Tuition Advance
Check this option if you are
requesting advance funding for a
course. Tuition Advance ONLY
applies for Western courses.
Please include:
Tuition Advance Policy signed
(page 2 of this form).
Copy of the invoice for fees.
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Western University
Application for Educational Assistance
Tuition Advance Policy
1. Financial support will be provided by means of a Tuition Advance for credit
courses at Western, ONLY if an initial course has been successfully completed in
accordance with the Educational Assistance Policy (except for UWOSA members
as per Article 22.08 in UWOSA Collective Agreement) and a copy of the invoice
for fees is included with the application.
2. Members of UWOSA who experience financial hardship as a result of the
requirement to pay tuition in advance may make application for an advance for
non-Western and non-credit courses.
3. You agree to provide evidence of successful completion of courses taken at
Western or otherwise, to Human Resources as soon as this evidence is available.
4. If the course(s) is/are dropped/withdrawn/failed, you should contact Human
Resources to arrange repayment of the money advanced to you. If your
employment is terminated prior to completion of the course, please contact
Human Resources (519-661-2194) to arrange the return of your Tuition Advance.
(Cheque should be made payable to Western University and sent to Human
Resources in SSB 4159).
5. You agree, as one of the conditions for receiving the Tuition Advance, that this
agreement constitutes your written authorization for the University to deduct
any such outstanding monies through payroll deduction (maximum $200 per
month) and/or from any monies owing to you upon termination of your
6. No further advances/reimbursements will be issued if there is any outstanding
amount owing.
Signature _________________________________
Date _____________________________________
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