NON-CREDIT TUITION WAIVER AUTHORIZATION
Anyeligibleemployee,spouse,domesticpartner,dependent,orretireeseekingthetuitionwaiver
MUSTfilloutthisformeachtermandsubmittotheContinuingEducationDepartmentintheCOCC
ChandlerLab.Toregister,call541.383.7270.NOTE:Alllabfees are due atthe time ofregistration.
_____________________________________________________________________________________
This waiver request is for … (Mark One):
Employee (Self)
Spouse
Retiree/Retiree Spouse
Domestic Partner**
Dependent Child (to age 25)
STUDENT or RETIREE INFORMATION:
Student / Retiree Name
Term
COCC ID (820#)
DOB
(Dependent children only)
COCC EMPLOYEE INFORMATION:
Classified
Administrative
FT Faculty
ABS
Adjunct Faculty ___
Employee Name (printed):
COCC ID (820#) Work Department:
Date of Employment:
Full Time
Part Time
POLICY REMINDER:
By signing this authorization, the staff member acknowledges and accepts the policies
and procedures stated in the Staff Tuition Waiver Policy (available online at /Employee
Login/HR Forms/Employee Related Forms/Staff Tuition Waiver Policy):
Employee / Retiree Signature ______
Lab fees must be paid at the time of registration and the tuition waiver form is due within 24
hours of registration or you will be dropped from the course. A new waiver form is required
for each term you register.
Submit this form to Continuing Education in the COCC Chandler Lab (NOT Boyle Education
Center) or email to ceinfo@cocc.edu.
** Tuition waivers are a taxable benefit for domestic partners and domestic partner dependents.
As such, they will be added to your taxable income as the waivers are incurred. The Domestic
Partner relationship must be documented (Affidavit must be on File with Human Resources for
eligibility).
If you have questions about eligibility, please call HR at 541.383.7216.
Rev JANUARY2018
