Fillable Dependent Child Fee Waiver (Boise State University)

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Dependent Child Fee Waiver (Boise State University)

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The Dependent Child Fee Waiver (Boise State University) form is 2 pages long and contains:

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  • 3 check-boxes
  • 26 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Boise State University

BROWSE BOISE STATE UNIVERSITY FORMS

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Original Application
Student Name Student ID # Birth Date
Permanently Disabled? Yes No
Enrollment status:
Full Time Student Part Time Student
I am registered as:
Undergraduate student
Graduate student
Employee Name ____________________ Agency/Department
Phone Number
REQUIRED Employee’s Signature Date
State Board Affiliate Agency: ________________________________________________________________
Phone Number: _____________________
Dependent Child Fee Waiver: Employee has been employed for 5 or more months in a benefit eligible position:
Yes ( ) No ( )
Supervisor’s Signature
or Affiliate
Approver:________________________________________ Date:___________
Boise State University – Human Resource Services
Request to Attend Classes with Waiver of Fees
Dependent Child Fee Waiver
(Only one dependent child per family may utilize this benefit in the same semester. Parents of a dependent
utilizing the fee waiver cannot also receive the employee or spouse fee waiver benefit)
HRS Office Use Only: Approved Disapproved/Reason
Questions on the reverse side must be completed and signed by the employee.
Student Information
Employee Information
I have read the Boise State Dependent Fee Waiver Policy Guidelines and certify that the above named student is my lega l
dependent as defined by the Policy, and will provide proof of dependency status if requested. I understand that this fee
waiver benefit may impact financial aid awards, and that the benefit may become taxable to me in the event that my child
does not qualify as my tax dependent as outlined on page 2 and/or is enrolled as a graduate student.
8/2019
Semester______________ Year______________
click to sign
signature
click to edit
______________________________________
_______________________________
Boise State University – Human Resource Services
Request to Attend Classes with Waiver of Fees
DECLARATION OF DEPENDENCY TAX STATUS
The value of the dependent tuition and fee waiver will be treated as a taxable benefit to you unless your child is an
undergraduate student and meets the Internal Revenue Code’s definition of a dependent as outlined below.
Please read this form carefully before making an election.
To qualify as an Internal Revenue Code Section 152 tax dependent for purposes of the dependent tuition and fee waiver,
an employee’s child must meet ALL of the following criteria:
(1) Be the employee’s unmarried child/stepchild (whether by blood or adoption) or foster child;
(2) Be under age 19 or a full-time student (carrying 12 credits at least 5 months of the current calendar year) under
age 24 (age determination made on December 31 of the 2017 year) or permanently and totally disabled as
defined by section 22(e)(3) of the Code;
(3) Live with the employee for more than one-half of the year (with the exception of allowable temporary absences);
(4) The child cannot provide more than half of his/her financial support for the year;
(5) The child cannot be classified as another taxpayer’s "qualifying child" (as defined in Code Section 152(c)), and
(6) The child must be a U.S. citizen, a U.S. national, or a resident of the U.S., Canada or Mexico.
The University is unable to provide individual tax advice. If you are uncertain whether your child qualifies as a dependent
for tax purposes, please contact your tax advisor for guidance.
Yes, my child qualifies as an Internal Revenue Code Section 152 dependent for the entire calendar year
_____ (enter current calendar year).
No, my child does not qualify as an Internal Revenue Code Section 152 dependent for the entire calendar
year of _____ (enter current calendar year) and I understand that the value of the dependent fee waiver will
be a taxable benefit to me.
By signing below you are stating that:
1. The above election is based on true and complete information. Willful falsification of a child’s tax dependency
status may constitute tax fraud.
2. You agree to notify the University within fifteen (15) business days if there is a change in your child’s status and
s/he no longer qualifies as an Internal Revenue Code Section 152 dependent. You understand that a change in
dependency status may have a direct impact on your taxable income.
Employee Signature Date
8/2019
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Dependent Child Fee Waiver (Boise State University)

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Completed 17 August 2020

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