Fillable EMPLOYEE AND/OR DEPENDENT TUITION WAIVER FORM (Bishop State Community College)

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EMPLOYEE AND/OR DEPENDENT TUITION WAIVER FORM (Bishop State Community College)

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EMPLOYEE AND/OR DEPENDENT TUITION WAIVER FORM
Employee’s Name Employee ID # &Position/Title
Phone # Email
Dependent’s Name Dependent’s Student ID or SS#
Phone # Email
Relationship to Employee: (check one)
Self Spouse Unmarried Natural or Adopted Child Unmarried Step-Child Legal Ward
Does the Dependent live with you? Yes No With former Spouse? Yes No
(Dependents must reside in the household of the employee or the employee’s former spouse. Exception: step-child must reside in the household of the employee)
Institution to Attend Term/Year
Course #
Course Name
Credit Hours
Online: Yes No
Audit: Yes No
Course #
Course Name
Credit Hours
Online: Yes No
Audit: Yes No
Course #
Course Name
Credit Hours
Online: Yes No
Audit: Yes No
Course #
Course Name
Credit Hours
Online: Yes No
Audit: Yes No
Course #
Course Name
Credit Hours
Online: Yes No
Audit: Yes No
I certify that I am familiar with the provisions of the Employee and/or Dependent Tuition Waiver policy and that the person(s) requesting the tuition waiver
benefits qualifies as an eligible employee or dependent in accordance with the policy. (See reverse of form for policy and/or processing steps).
INITIAL BY EACH ITEM
AND SIGN BELOW
All fees (other than portion of tuition waiver), books and supplies are the responsibility of the student
Maximum of one audit per term
Waiver does not apply to repeated courses
Student must abide by the academic limitations and policies of the attending institution (including any course limitations)
Unofficial Transcripts (and current course schedule) must be attached to this form
It is the responsibility of the employee and/or dependent to ensure that all documents and forms (requested by the college where the student is enrolled) are
submitted and signed by the appropriate personnel in a timely manner prior to submission. Any packets deemed as incomplete will cause a delay in the processing
of the tuition waiver. Please be sure to check with the college in which you are registered for courses to ensure the packet is complete.
Employee Signature
Date
Supervisor (if required)
Date
This section to be completed by the Human Resources department at the institution of employment.
Certification:
Full Waiver
2/3 Waiver
1/3 Waiver
Full-time Employment Date
Date of Employee
Retirement
*Dependents are eligible for waiver for a maximum of 5 years from date of employee retirement.
Certifier Name:
Title:
Date:
This section to be completed by the appropriate college official at the institution of attendance.
Certification:
Student’s GPA is at least 2.0?
Yes
No
Certifier Name:
Title:_____________________
Dept/Division:
Date:
This section to be completed by the President at the institution of attendance.
Based on the certified information above, I hereby certify that
has been approved to receive all benefits granted under
the Employee and Dependent Tuition Waiver Program for
hours at the institution of
President:
Date:
Notes:
Revised April, 2016
GUIDELINES FOR POLICY
612.02: TUITION ASSISTANCE
I. GENERAL
This tuition waiver program is designed for all full-time and Salary Schedule H-35 employees of The Alabama College System and the Alabama
Department of Postsecondary Education and their dependents as defined under Section II. Courses taught by Athens State University are not subject to
this policy.
The program will be coordinated by each institution for employees within The Alabama College System and the Alabama Department of Postsecondary
Education. An application form for the tuition assistance program is available at each institution and should be completed prior to registration for classes.
A copy of the completed form must be maintained by the employing institution and the institution offering courses (if different).
II. DEFINITIONS
Employee: Any full-time or Salary Schedule H-35 employee of any System institution and the Alabama Department of Postsecondary Education. This
program will not include temporary or part-time employees (other than Salary Schedule H-35 employees), or persons serving as independent contractors
to any of the System institutions or to the Alabama Department of Postsecondary Education.
Dependent: The spouse of any full-time employee, the unmarried, natural or adopted children of any full-time employee, residing in the household of the
employee or the employee's former spouse; the unmarried stepchildren of any full-time employee, residing in the household of the employee; a legal ward
(a minor child placed by the court under the care of a guardian).
III. ELIGIBILITY
A. Requirements
Employees: Employees must have been employed by a System Institution or the Alabama Department of Postsecondary Education for one full academic
year or at least 12 months, whichever is less restrictive, prior to the first scheduled day of class for the term for which the employee is applying.
Employee eligibility will remain in effect for the duration of their employment in The Alabama College System or the Alabama Department of
Postsecondary Education.
B. Termination of Eligibility
Employees: Eligibility terminates if the employee discontinues full-time employment at the respective institution for any reason except on an approved
leave of absence.
Dependents: Dependents will be ineligible when said employee becomes ineligible, except that dependents of any employee who has 25 years of more of
continuous service in The Alabama College System or the Alabama Department of Postsecondary Education upon retirement from The Alabama College
System or the Alabama Department of Postsecondary Education are eligible to participate in the program for a five-year period commencing with the date
of the employee's retirement.
IV. AMOUNT OF ASSISTANCE, LIMITATIONS, CONDITIONS, AND AUDITING
A. Tuition Cost
All eligible employees and their dependents will be allowed a waiver of one-third of the normally-charged tuition after the first year (full academic year
or 12-month period) of employment; a waiver of two-thirds tuition after the second year of employment; and a waiver of full tuition after the third year of
employment (partial tuition adjustments are to be rounded down to the nearest dollar). Salary Schedule H-35 employees will be allowed a waiver
calculated at a prorated rate of full-time employment. Expenses for supplies, books, and fees other than tuition will not be waived. Each institution will
be allowed to count the credit hours generated by these enrollees.
B. Limitation
There is no limitation as to the number of credit hours taken, other than the regular academic limitations that apply at the respective institutions. All
students will be required to abide by the academic policies that are in effect at the institution they are attending.
Dependents: Dependents will be eligible when said employee is eligible, and to the same degree to which the employee is eligible, except as herein
modified.
C. Conditions
To be eligible for tuition waiver, the student-employee or dependent must maintain at least a "C" (2.0 on a 4.0 scale) in the courses for which he/she
receives tuition assistance. Failure of the student-employee or dependent to meet this grade requirement will result in the employee or dependent's
having to pay tuition for courses taken until his/her average grade is "C" or better. The student-employee or dependent can then again be eligible when
his/her cumulative grade point average is brought back up to the "C" requirement.
D. Auditing
The student-employee or dependent will be allowed to audit one course (up to five credit hours) per term at no cost.
The student-employee or dependent must meet all attendance requirements, class participation, and assignments as required of credit-enrolled students
except the final examination is not required. Failure to comply with these requirements will result in the student-employee or dependent becoming
ineligible for further participation as an audit student in credit hour-producing courses reported for funding purposes.
E. Repeating Class
Tuition costs for courses repeated will be the responsibility of the student-employee or dependent and consideration under the tuition assistance program
will be disallowed. Tuition assistance will be disallowed for repeating a class for which the grade of "W" was originally received.
F. Records Transmittal
The student-employee or dependent must re-certify eligibility, as specified in Condition IV.C. above, prior to registering for a new term by providing
verification of course completion to:
1. The Academic or Technical Dean at the institution of attendance; and/or
2. The Academic or Technical Dean at the institution of employment who will forward it to the President for the student-employee's or dependent's
permanent file.
Those not registering for the next term must, within twenty (20) days after course completion, present official documentation of course completion
to:
1. The Academic or Technical Dean at the institution of attendance; and/or
2. The Academic or Technical Dean at the institution of employment who will forward it to the President for the reportee's permanent file.
G. Work Week
Participation in this program is in addition to the employee's full-time work week, and should not be considered when computing the employee's time
for financial compensation. However, in certain cases the employee's work schedule may be adjusted to permit course attendance. Adjustments to an
employee's weekly work schedule must be recommended by the employee's supervisor and/or Dean, and approved by the President.
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EMPLOYEE ANDOR DEPENDENT TUITION WAIVER FORM (Bishop State Community College)

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Completed 25 July 2020

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