DEPENDENT TUITION DISCOUNT FORM
2/1/2019
1. After registration, submit this completed and signed form to the HR/Tuition Program Office on Cocoa
Campus either by campus mail or by email to Tuition@easternflorida.edu
a minimum of 5 (five) days prior to
fee-due date to ensure timely processing.
2. HR will review for eligibility and, if approved, submit to Accounting; the tuition discount will be applied at that
t
ime.
Name: Date: Term:
Date of hire:
Employee B number: B
Job Category (choose most appropriate):
Full-time employee, non-faculty
Regular part-time employee, non-faculty
Full-time faculty
Part-time (adjunct) faculty
Part-Time
Faculty
If PT Faculty, mark your selection for the following:
Length of time teaching (select one):
Teaching Schedule (select one):
6+ semester hours during previous academic
year
Less than 6 semester hours/previous academic
year
Teaching at EFSC during dependent’s time of
course completion
Not teaching at EFSC during dependent’s time
of course completion
Name:
Relationship to Employee:
Dependent B number: B
Employee
Verification
I have attached a copy of the most recent Internal Revenue Income Tax Return or a copy of the
appropriate court document(s) verifying proof of dependency.
B
y checking the box above and by signing below, I verify that the information given is correct.
I will submit this completed electronic form to the HR/Tuition Program Office on Cocoa Campus either in
person or by email to Tuition@easternflorida.edu
.
S
ignature: ______________________________________________________________________
HR
Date Received:
HR Initial: ________
AVP Initial: _______
HR Notes:
Instructions to Accounting Amount to Discount: $
click to sign
signature
click to edit
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