Fillable Graduate Tuition Remission Eligibility form for EMPLOYEES (Elizabethtown College)

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Graduate Tuition Remission Eligibility form for EMPLOYEES (Elizabethtown College)

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The Graduate Tuition Remission Eligibility form for EMPLOYEES (Elizabethtown College) form is 1 page long and contains:

  • 2 signatures
  • 4 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

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Graduate Tuition Remission Eligibility form for EMPLOYEES
This request form must be completed and submitted to Human Resources
prior to the start of each academic year in which remission is requested.
Send the completed form to HR (hr@etown.edu
).
Employee Information
Name:
ID #:
Email Address:
Phone:
Address:
City, State, ZIP
Status:
Full-time Part-time*
Full-Time Hire Date:
Dept:
*part-time employees are not eligible for this benefit
Graduate Tuition Remission
Semester and Year:
Is this for a study abroad semester?* Yes No
SCPS Session:
Course Name:
SCPS Session:
Course Name:
SCPS Session:
Course Name:
SCPS Session:
Course Name:
*Study abroad must be a requirement of the major in order to use tuition benefits
50% of tuition costs will be assessed per course. The Business Office will bill the employee directly.
This benefit is limited to four employees per academic year. Benefit eligibility approval does not guarantee admission
into the graduate program. Admission into the graduate program is determined by SCPS.
By signing below, it signifies that I understand that if I fail a course or do not complete a course, I will be responsible
for reimbursing the College for costs incurred for the course. My signature provides authorization for my course
grades to be released to Human Resources. My signature also signifies that I am aware of the full policy which can
be found on page two of this document.
Employee’s Signature:
Date:
I certify that the information contained in this form is true and accurate.
Approval (to be completed by Human Resources)
Eligible
Non-eligible
Reason for non-eligibility:
Signature of HR representative:
Date:
Cc: Requesting Employee, Financial Aid, Director of Business Operations, Dean of SCPS
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Graduate Tuition Remission Eligibility form for EMPLOYEES (Elizabethtown College)

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Completed 20 August 2020

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