EMPLOYEE REQUEST FOR TUITION EXEMPTION / EDUCATION LEAVE
EMPLOYEE NAME: ______________________________________ BANNER ID: ________________________
DEPARTMENT: _________________________________________ POSITION: _________________________
Semester (Check One):
□ Fall □ Spring □ Summer □ Other _________________
YEAR: _______________ Name of Institution (Check One):
□ Other LCTCS Institution
□ SOWELA Technical Community College □ Other (Specify) _______________________________________________________
Are you requesting Tuition Exemption*? □ YES □ NO
Note: All fees, except for tuition, required for enrollment are to be paid by the employee.
Are you requesting Education Leave**? □ YES □ NO
If “Yes” to either question above, explain how this course(s) is related to your job:
Enter time (hh:mm – hh:mm) under the appropriate day(s) you are requesting educational leave (Should equal a total of 3 hours**).
*Note: Tuition exemption is only applicable for LCTCS institutions.
**Note: Educational Leave is limited to the equivalent of a 3 credit hour course, no more than 3 clock hours per week; for classified employees, a maximum of 30
calendar days per calendar year (C.S. Rule 11.24(b)).
I understand that continued participation in this tuition exemption program will be based on making satisfactory progress as determined by the employee’s supervisor.
Satisfactory progress shall generally be interpreted to include completion of the course with a passing grade. I hereby give permission to release my final exam grade
and/or course grade for course(s) listed above to my supervisor and the Office of Human Resource.
Employee Signature: _______________________________________________ Date: _______________________________
SOWELA Technical Community College does not discriminate on the basis of race, color, national origin, gender, disability, or age in its programs or activities.
The following person has been designated to handle inquiries regarding the non-discrimination policies:
Title: Compliance Office
Address: 3820 Senator J. Bennett Johnston Ave, Lake Charles, LA 70616
Telephone No: 337-421-6565 or 800-256-0483
EMPLOYMENT ELIGIBILITY / APPROVALS
Verification of Employee’s Eligibility: The employee stated above is a currently employed, full-time (100%) employee of SOWELA Technical Community College and has
been employed by the College in a full-time, permanent position for at least 1 (one) year.
Immediate Supervisor: ______________________________________________ Date: _______________________________
Vice Chancellor (if applicable): ________________________________________ Date: _______________________________
Director of Human Resources: ________________________________________ Date: _______________________________
Chancellor (if school is outside LCTCS): _________________________________ Date: _______________________________
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