To submit: Preferred — Email to edubenefits@uky.edu. Alternative — Deliver in person to Scovell Hall or fax to 859-323-8494.
If you have questions about this form, please call 859-257-8772 or email edubenefits@uky.edu. For more information, visit
our website at www.uky.edu/hr/benefits/more-great-benefits/employee-family-education-program.
EMPLOYEE INFORMATION
Last name First name Middle initial
Employee ID # Email address
Phone Please select one: Faculty Staff CKMS ESH
ACADEMIC INFORMATION
Student ID # Year
Academic term (only one per form) Fall Winter Spring Summer I Summer II
Level of study Graduate Undergraduate (Graduate-level waivers in excess of $5,250 per calendar year are subject to taxation.)
Classes will be taken at (select only one school per form)
Eastern Kentucky University Kentucky State University Morehead State University
University of Louisville Western Kentucky University Northern Kentucky University
KCTCS (Indicate college)
*Those attending Murray State University must submit a Murray State University CPE Tuition Waiver enrollment form.
COURSE SCHEDULE
Course name Course # Section Days course meets Course time Enrolled Removed Credit hours
Should any changes occur, such as adding or dropping a class, please submit an updated form. Per UK HR Policy 51.0: “A regular full-time employee of a postsecondary
public institution or a state or locally operated technology center may, with prior administrative approval of the course offering institution, take a maximum of six (6) credit
hours per term at any [Kentucky state funded] public postsecondary institution.
Do any of your courses occur during work time? Yes No
If yes, please describe below how work hours will be made up, then acquire both signatures below. If your supervisor is your
director, please have them sign both lines. If no, please proceed to employee signature.
Per HR Policy 51.0, “a regular, full-time employee shall be permitted, with prior administrative approval, to take only one (1) course
for credit per semester (or combination of summer sessions) during the employee’s normal working hours.” The approved manner
in which scheduled work hours will be made up is as follows:
Supervisor signature Date Director signature Date
I certify I am not applying for a waiver of more than six hours per semester (eight if attending UK) from this institution or a combination of institutions and that the
information provided on this form is true and correct to the best of my knowledge. I have read and understand the University of Kentucky policy pertaining to the
Employee Education Program and that graduate-level tuition waiver amounts that exceed $5,250 per calendar year are subject to taxation via payroll deduction.
Incomplete forms will not be processed. It is the responsibility of the employee to ensure forms are recieved in accordance with posted deadlines.
Employee signature Date
Faculty and Staff Tuition Waiver Form
NOTE: Only those who applied to or enrolled at another university and were
benefits-eligible UK employees before April 26, 2018, are eligible for the tuition waiver
Office use only (do not write in this section)
Eligible hours Person ID Post # Org unit #
Aid ID Aid amount Benefits rep signature Date
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