Registration Office Verification Yes No Initials Date
Cashiers Office Processed Yes No Initials Date
Florida College System institutions and state universities may waive up to six credit hours per term for teachers
employed full-time by a school district, including public charter school teachers. Qualified students may only enroll in
undergraduate courses in mathematics, science or special education. Eligibility for the waiver is on a space-available
By completing this form you are requesting approval from your school district to participate in this program.
Last Name: ________________________________ First Name: ___________________________ MI: _______
Name of School where you are a full-time Teacher __________________________________________________
Address ___________________________________________ City ________________________________________
State _____________________________________________ Zip Code ____________________________________
E-mail Address _____________________________________ Phone # _____________________________________
I am requesting a waiver for: Fall Winter Summer Year _____________
Course ID Name of Courses (Course Title) # Credit Hours
I, the undersigned, acknowledge the following:
My tuition and fee waiver will apply to no more than six credit hours per term.
I must register for classes during the classroom teacher registration period prescribed by Broward College.
All other charges/fees are my responsibility.
My ability to secure the courses I request depends on space availability.
NOTE: Participating employees should be aware that Broward College may require you to provide your social security
number to verify employment.
_______________________________________________________ _______________________________________
Employee Signature Date
School Authorization
I authorize the above named employee to participate in the Tuition and Fee Waiver for Classroom Teachers Program. I
certify that this employee is a full-time classroom teacher.
________________________________________________________ _______________________________________
Principal’s Name (Print) Signature
Phone# _________________________________________________ Date __________________________________
Print Form
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