08/2019
Application for Tuition Waiver for Spouses,
Dependents, Couples in a Civil Union and
Domestic Partners
Semester , 20
Semester Hours (Credits)
Credits completed to date:
Name of Employee: Z#
Union Affiliation (if applicable):
Employee Signature: Date:
Division:
Department:
Fund: Org: Program:
Campus Telephone
Name of Dependent:
Dependent Z # Date of Birth:
o Tuition Waiver benefits are ONLY available after an employee has been employed for one year.
o Must be a full-time student at the time of enrollment. A student's eligibility for tuition waiver is limited to five years
from the time he or she becomes a full-time undergraduate student at the University. Each student is eligible for
only one undergraduate degree and the waiver is limited to a period of eight semesters.
o If a dependent child, a copy of a certified birth certificate verifying that child is twenty-six (26) years
of age or younger. Domestic partners or those in civil union must have documentation of this relationship on file
in Human Resources
o LEAVE OF ABSENCE: Unless prohibited by law, Tuition Waiver benefits will cease during a leave of absence that is one
month or longer in duration.
Human Resources Representative:
Date:
Applications should be received by Human Resources 30 days BEFORE the start of
the Fall/Spring semester.
COMPLETED APPLICATIONS SHOULD BE RETURNED TO
THE OFFICE OF HUMAN RESOURCES, J115
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