Dependent Child Tuition Scholarship Application
Spring 2020/Summer 2020
Date _____________________
Name of Admitted Student _________________________________________________
Student UMID # ___________________ Student Email __________________________
Semester: _____ Spring 2020 – Application deadline is Tuesday, May 5, 2020 at 5pm (2019 tax return)
_____ Summer 2020 – Application deadline is Tuesday, June 30, 2020 at 5pm (2019 tax return)
Fall 2020 -- Application deadline is Tuesday, September 8, 2020 (2019 tax return)***
_____ Winter 2021 -- Application deadline is Tuesday, January 12, 2021 (2019 tax return)***
*** Fall 2020 and Winter 2021 semesters will be part of the new
Dependent Tuition Scholarship program will require completion of a separate application***
Please note:
Deadlines will be strictly enforced.
Candidates must show the employee’s most recent federal tax form as supporting documentation of the dependent
status of the student.
Income Tax verification will not be used for other Financial Aid purposes.
If approved, the tuition scholarship will be applied to the students account after 10
day of classes (count day).
See Guidelines and FAQs for criteria and policies of this program. (
One form may be used for all semesters.
Name of UM-Flint Employee _______________________________________________
Department ______________________________________________________________
Employee UMID # ________________________________________________________
By checking this box, we confirm that the student listed above is an IRS-dependent child or an IRS-dependent child
of a spouse or a domestic partner living in the same home. We also give permission to confirm parental/legal guardian
employment status now and every semester covered by this scholarship program to the Offices of the Registrar and
Financial Aid.
______________________________________ ___________________________________
Student Signature Parent/Legal Guardian Signature
Name/Date of HR Representative who verified tax forms:
Name _________________________________________
Date _________________________________________
Please deliver this form and supporting document(s) by the appropriate application deadline to:
Human Resources, 213 University Pavilion