Fillable Dependent Of Employee Tuition Remission Application U

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Dependent Of Employee Tuition Remission Application U

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UNIVERSITY OF DAYTON
OFFICE OF HUMAN RESOURCES
TUITION REMISSION APPLICATION
FOR
DEPENDENT CHILD OR SPOUSE
Term
Please check one of the following: Undergraduate Graduate Law School
Employee Name
Employee Identitfication #
Child’s or Spouse’s Name
Child’s or Spouse’s Student ID #
Child’s Date of Birth
UNDERGRADUATE
I wish to receive Undergraduate tuition remission for my dependent child or spouse indicated above. If the
above named person is a dependent child, I certify that he or she is claimed by me for income tax purposes for this
tax year.
GRADUATE
I wish to receive Graduate tuition remission for my dependent child or spouse as indicated above. If the above
named person is a dependent child, I certify that he or she is unmarried and claimed by me for income tax
purposes. I understand that all graduate tuition remission for dependents is considered to be taxable income by
the Internal Revenue Service. I understand that the amount of graduate tuition remission will be added to my
gross pay each applicable term, and all taxes will be withheld accordingly. Eligibility for graduate tuition
remission: refer to your Employee Handbook.
Deduct appropriate social security, state, local and federal taxes
Deduct appropriate social security, state, local and 28% federal taxes
Shortly after the beginning of the term, you will be notified by copy of a Personnel Action Form (PAF) as to the
amount on which you will be taxed and the number of pays over which the tax will be taken.
NOTE: Only one application for tuition remission per Student per academic year is required.
Date
Employee Signature
VERIFICATION OF EMPLOYMENT
Date
Office of Human Resources
Account #91590
Sub Account
%
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Dependent Of Employee Tuition Remission Application U

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Completed 24 February 2020

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