THE UNIVERSITY OF SOUTHERN MISSISSIPPI
FACULTY AND STAFF TUITION WAIVER
Date ___________________________
Semester _______________________ Academic Year ___________________
CERTIFICATION
All full-time benefit-eligible employees of The University of Southern Mississippi are eligible for up to six (6) credit hours,
per semester with only three (3) credit hours taken during the work day. Part-time (less than 40 hours) benefit-eligible
employees are eligible for up to three (3) credit hours, per semester. Part-time employees are not eligible to take the
course during their normal work schedule. I understand that I must maintain a semester 2.0GPA to continue the free
course benefit.
_______________________________
Name of Employee (Print)
Student Status: □ Undergraduate □ Graduate
_____________________________________ ________________________________
Signature of Employee (See Certification) Employee ID Number
APPROVAL (Director)
I have read and understand the procedures related to the Faculty/Staff Academic Policy 4.2. I also certify that I
am the approving authority for the department budget and have verified the eligibility of the above employee.
__________________________________ __________________________________
Name and Title (Print) Department
__________________________________
Signature
1. Instructions
a. Complete this form. You will need to be registered for classes in order for it to be processed.
b. Return this form to Human Resources (Box 5111). The form must be returned no later than: July 1 for Fall
semester, December 1 for Spring semester, and May 1 for Summer semester.
2. Employees maintaining a permanent residence outside the State of Mississippi will be responsible for payment of
out-of-state tuition.
3. Tuition for graduate coursework exceeding $5,250.00 is taxable.
4.
Employees are responsible for all fees associated with the course.
5. Employee must be employed on the first day of classes (as reflected in the USM Academic Calendar).
6. If employee terminates on or prior to drop date of a semester, employee will be required to pay full tuition for the
course.
FOR HR USE ONLY:
Staff member eligible for: □ 6 semester hours □ 3 semester hours
Date entered: __________ Entered by: _______
Date received: ________
HR-5/2019
Employed □ Full-time □ Part-Time
Emploment Status Regular Full-Time Regular Part-Time
