I apply for a tuition reduction for the following: Semester: Year:
Last Name: First Name: Middle Initial: Date of Birth:
Last 4 digits of Soc. Sec. #: or LOLA Student ID#:
College Where Attending:
By signing this application, I have read and agree to the terms and conditions outlined in STCC Policy No. 6.0XX Child or Dependent
and Spouse Tuition Reduction. I also understand that I will pay the remaining student tuition & fees in accordance with STCC
semester payment deadlines.
Student Signature: Date:
Qualifying Employee: Date:
EMPLOYEE CHILD, DEPENDENT, OR SPOUSE TUITION REDUCTION APPLICATION
EMPLOYEE INFORMATION
Employee ID: Dept:
Last Name: First Name: Middle Initial Contact Number:
College Where Employed Employee Banner/LOLA ID#: Check One:
Full-time Faculty Full-time Staff Other
CHILD, DEPENDENT, OR SPOUSE INFO
Check only one: Eligible Child Eligible Dependent Eligible Spouse
HUMAN RESOURCES OFFICE
This employee is eligible for the tuition reduction requested per STCC Child or Dependent and Spouse Tuition Reduction Policy
No. 6.0XX. This child, dependent, or spouse is considered eligible and has provided all appropriate documentation which
indicates that the person qualifies as a child, dependent, or spouse of an eligible employee.
Length of Service at STCC:
___________________________________________________________ ____________________________________
Signature of HR Verifier or Designee Date
__________________________________________________________ _____________________________________
Signature of Director of HR or Designee Date
HOME / HOST CHANCELLOR APPROVALS (Only needed if attending an LCTCS College other than SOWELA)
Chancellor Signature (Home): Date:
Chancellor Signature (Host): Date:
ddd ddd
Employee should return original to the HR Office
HR Office to verify and Submit to the Business Office for Waiver Processing
Date Processed by Business Office:
SOWELA Technical Community College does not discriminate on the basis of race, color, national origin, gender, disability, or age in
its programs or activities.
The following person has been designated to handle inquiries regarding the non-discrimination policies:
Title: Compliance Office
Address: 3820 Senator J. Bennett Johnston Ave, Lake Charles, LA 70616
Telephone No: 337-421-6565 or 800-256-0483
Email: complianceofficer@sowela.edu
Last updated: January 22, 2019
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