Fillable Dependent Tuition Form (Idaho State University)

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Dependent Tuition Form (Idaho State University)

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ISU APPLICATION FOR EMPLOYEE DEPENDENT TUITION REDUCTION
Please return completed form to Human Resources, located on the 3
rd
floor of the Administration Building,
at least 14 days before the first day of the term.
Dependent Student Information
Student’s Name
Semester Year
Student’s Bengal ID Number Student’s DOB_
/_
/
Parent/Guardian Information
Employee’s Name
Employee’s Bengal Number
Spouse’s Name
Spouse’s Bengal Number
(if available)
Verification Information for Student
Check if “yes” is the correct answer for the questions below:
Is student married?
Date
Is student under the age of 26? ________________________
Date of 26
th
Birthday
Is student listed as dependent on employee’s ISU health insurance coverage?
Policy # Insurance Co.
Is student listed as dependent on spouse’s health insurance coverage?
Policy # Insurance Co.
Is student my biological child, stepchild, or legally adopted child?
Do I intend to claim the student as my dependent on my federal tax return for the 20 calendar year?
If the student is not a dependent under the U.S. Internal Revenue Code and is not listed as a dependent on the
employee’s tax return, the financial amount of the reduction is generally considered taxable income to the employee.
Please consult with a tax adviser for additional information.
I hereby solemnly affirm that:
a. The information given above is true and accurate;
b. I understand that willful falsification of information in this Application can result in a) disciplinary action by
Idaho State University up to termination, b) civil action by Idaho State University to recover any costs that it
may incur because of such a false statement, and c) criminal prosecution; and
c. I understand that I must notify Human Resources no later than 15 days of my first becoming aware of any
change in the information that I have provided in this Application and as a result, I understand that the value of
the tuition reduction may be taxable income to me and applied retroactively to the appropriate taxable year. I
further understand that failure to notify Human Resources of any changes may be considered willful
falsification, to be treated as described in item b. of this section.
Employee Signature
Date
Student Signature
Date
HR AR
Payroll
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 6-part definition of a dependent as outlined below.
Please read this form carefully before making an election. Please return completed Application and Declaration
form to Human Resources, located on the 3
rd
floor of the Administration Building, at least 14 days before the first day
of the term.
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 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 current year);
(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 may not 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 your child’s tax
dependency status may constitute tax fraud.
2. You agree to notify the Office of Human Resources with a revised Declaration of Dependency Tax
Status 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
Description:
Employee Dependent Tuition Reduction Benefit
The Idaho State University (ISU) employee dependent tuition and general fee benefit provides for a 50 percent reduction of resident (in
state) student tuition and general fees for dependents of eligible ISU employees. The reduction applies for either a part-time or full-time
course load. The benefit is limited to 18 credits per semester or summer session. The reduction does not affect the ability of the dependent
to a) fully participate in ASISU activities or b) utilize facilities on campus.
Benefit-eligible faculty and staff can continue to utilize the current employee/spouse fee waiver benefit for themselves and their
spouses, even if the family is utilizing the dependent reduction that same semester or session.
The dependent reduction benefit is applicable for Idaho State University eligible employees and their eligible dependents enrolled at
Idaho State University; the reduction does not apply to courses taken at other Idaho public universities.
The dependent fee reduction benefit is a year-to-year benefit that is evaluated each spring and is subject to revision and or termination
by the University. The initial term began in the fall of 2013.
Employee Eligibility:
Benefit-eligible faculty and staff who are employed half-time or greater as of the first day of classes for a particular semester or session
(“term”) are eligible to utilize this benefit for one dependent that same semester or session. If both spouses are eligible employees, they are
still limited to just one dependent for the family for a particular term. Other employee eligibility criteria include:
• Employees on leave without pay (except for approved medical leave) are not eligible for the benefit.
• If an eligible employee is called to active military service or goes on sabbatical, the benefit can still be utilized for a dependent while the
employee is away from campus.
• If an eligible employee becomes permanently disabled or dies while employed at ISU, the benefit will continue for the dependent who
was receiving the reduction.
• If an eligible employee voluntarily resigns or is terminated prior to the midpoint of the current term, the dependent will be charged the
full amount of tuition and fees for the current term’s courses in which the dependent is enrolled.
• The reduction benefit does not apply to course- and program-specific fees (e.g., course fees, lab fees, on-line course fees, professional
fees, and other such additional fees).
• Tuition for study abroad is not eligible for the fee reduction.
• Employees of the Office of the State Board of Education and the Division of Professional-Technical Education shall be treated as ISU
employees for purposes of eligibility.
Dependent Eligibility and Related Criteria:
An eligible dependent is defined as someone under the age of 26 and not married as of the first day of classes for the term for which the
reduction is applied and who is claimed on a) the employee’s or the spouse’s health insurance policy or b) the employee’s federal income tax
return. If a dependent turns 26 or marries after the first day of a term, the benefit will no longer be available for subsequent terms, but will
continue through the current term. Other dependent eligibility criteria include:
• Only one dependent per family (one or both parents are benefit eligible employees) may receive the benefit during a particular term.
• Eligible dependents must meet all admission requirements and be admitted to the University to be eligible. The dependent tuition and
fee benefit does not guarantee admission to the University or to a specific program.
• The dependent must be a credential- or degree-seeking student.
• The benefit may be used for eligible students enrolled in professional-technical or academic undergraduate credit-bearing courses. The
benefit does not apply to non-credit courses, audited courses, or continuing education courses.
• The dependent benefit is available until the dependent reaches one of the following three checkpoints:
o completes an accredited bachelor’s degree program,
o attempts 140 credit hours, or
o has been enrolled in college for 12 terms.
• Dependents enrolled in programs that combine undergraduate and graduate credits (e.g., joint B.S./M.S., etc.) are eligible for the
reduction until either a) the student’s record reflects his/her primary program is at the graduate level or b) the student completes 140
credit hours, whichever comes first.
• The tuition benefit will reduce the dependent’s calculated cost of attendance for financial aid purposes. For dependents who have been
awarded financial aid, this could result in a decrease in their aid. Students concerned about any reductions should contact the Financial
Aid Office before submitting the tuition reduction form. Once the form has been submitted, Financial Aid will be notified and will adjust
the dependent’s financial aid package as appropriate.
• A student receiving 4 year Institutional Scholarships from Idaho State University may not be eligible for the reduction or may have this
benefit reduced. A student is not able to receive more than the amount of full in-state tuition for a given semester when combining the
Institutional and Employee Dependent benefit together.
• A dependent tuition reduction may be taxable income to the employee. The employee should consult a tax adviser on this issue. If the
ISU payroll office determines the reduction could be taxable income, taxes will be deducted from the employee’s paycheck.
Applying for the Employee Dependent Reduction:
Completed, signed applications must be brought to Human Resources by the registration deadline for the term for which the student is
enrolling. The application form requires signatures of the employee and the employee’s dependent as well as approvals of the offices of
Human Resources, Accounts Receivable and Payroll. The benefit is not automatically renewed; a completed, signed application must be
submitted for each term in accordance with these guidelines.
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Dependent Tuition Form (Idaho State University)

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Completed 27 July 2020

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