Arkansas Tech University
Office of Human Resources
Application for Faculty/Staff Waiver
I hereby apply for aid for on-campus study during the __________________ term, 20______.
Employee Information required for processing:
Employee Name: _______________________ Employee I.D. #: _____________________
(T number)
Dependent Information (if applicable): ( ) Spouse ( ) Unmarried Dependent
Dependent birthdate: ______________ (Children must NOT have reached 23
rd
birthday by the FIRST day of class)
Class Status: ( ) Graduate ( ) Undergraduate
Student I.D. # Last Name First Name M.I.
(specify times below)
Course Number and Name M T W R F S
Policy requirements for faculty and staff members:
▪ Courses must meet the Policy approved by the Administrative Council for Tech employees taking classes during regular
working hours.
▪ Dependent children must be unmarried and must not have reached their 23
rd
birthday by the first day of class.
▪ Reduced fee for dependent applies only to tuition not otherwise covered by scholarships.
▪ The faculty/staff waiver will be credited to the student’s account UPON COMPLETION OF THE 80% TUITION REDUCTION
PERIOD. (Please see current schedule of courses for exact date.)
▪ Forms are to be completed and approved during registration/classification.
_____________________________________ ____________ ___________________________________________
Signature of Employee OR Dependent Date Supervisor Signature (Required for Employees only)
_________________________________________ ________________________________________________
Human Resource Office Approval Director/Dean Signature (Required for Employees only)
________________________________________________
Vice President/Chancellor Signature
(Required for Employees only)
_________________________________________ ________________________________________________
Budget and Sub Code Discount Amount
For office use only
HR____________________________ Fin. Aid. _______________________ HR_______________________________
ATU-009 7/07
