Educational Assistance Plans - Employment Status Verification
The purpose of this verification is to affirm that the person stated below is eligible for employee, or employee
spouse/domestic partner/dependent child educational assistance benefits.
1. Potential student identifies themselves as eligible for benefits
2. Appropriate verification and form should be obtained from:
- Financial Services
at Union College for Union College employees, spouses, domestic partners,
and/or dependent children
- UGC for UGC employees, spouses, domestic partners, and/or dependent children
3. Union College Financial Services or Representative
at UGC will verify or deny status and return the form
to the student so that they can register.
4. A copy of this Employment Status Verification form should go with a copy of the registration and
a copy
should be retained by Financial Services.
Dependent Child
Name of Student/Applicant:_____________________________________ Year of Birth: ____________
Relationship to Employee:
Self
Spouse
Domestic Partner
Dependent Child*
* To qualify as a dependent child, the child must: 1.) receive over half of support from employee, 2.) be an eligible
child per the policy and 3.) has the same principle place of residence as the employee.
Yes
No
Category of Study:
Part-time - Degree Seeking
Part-time – Non Degree Seeking (Undergraduate only)
Is Student Pursuing Courses or Degree in Engineering?
Yes (Follow Engineering Guidelines)
No
Name of Employee:_____________________________ ID#__________________
Union College Employee
Union Graduate College Employee
Employee’s Department:__________________________ Full Time:
Yes
No (Benefit only available to
Full Time employees)
Employee Signature Student Signature (if applicable) Date
FINANCIAL SERVICES/UGC VERIFICATION
These columns for office use only
SOM SOE ENG/CS BE
Union Graduate College Employee
102 202 302 402
Union Graduate College Spouse, Domestic
102 202 302 402
Partner or Dependent Child
Union College Employee 100 200 300 400
Union College Spouse, Domestic Partner 100 200 300 400
or Dependent Child
Employee is Full Time
Status Reviewed and Verified
Status Reviewed and Denied
Union College Financial Services or UGC Representative Signature Date
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