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ORANGE COUNTY COMMUNITY COLLEGE
MIDDLETOWN, NEW YORK
FACULTY AND STAFF & CHAIRMEN’S ASSOCIATIONS
ADJUNCT FACULTY
DEPENDENT/SPOUSE TUITION WAIVER
This form authorizes the waiver of tuition and fees for the dependent or spouse of Faculty or Staff &
Chairmen Association members and Adjunct Faculty. Present this form to the Bursar office once
authorized signatures are completed.
The student (dependent/spouse) must complete the admission requirement and be accepted into a degree
or certificate program. This waiver is for credit courses and associated fees, only.
Full Time Day Adjunct Evening Adjunct
EMPLOYEE: _________________________________________________________________
STUDENT: ___________________________________________________________________
RELATIONSHIP TO EMPLOYEE: _______________________________________________
SEMESTER: __________________________________________________________________
For Adjunct Faculty: This form authorizes the waiver of tuition and fees on a pro-rated basis.
Example: If employee is teaching 12 credits/16 contact hours = 100% waiver
If employee is teaching 9 credits/12 contact hours = 75% waiver
If employee is teaching 6 credits/ 8 contact hours = 50% waiver
If employee is teaching 3 credits / 4 contact hours = 25% waiver
HOW MANY CREDITS ARE YOU TEACHING? WHAT SEMESTER ARE YOU TEACHING?
________________________________________ _________________________________________
SUBMIT THIS FORM TO THE HUMAN RESOURCES OFFICE FOR AUTHORIZATION
AUTHORIZED:
Approved for ________________________ % Waiver
Human Resource Officer:_________________________________ Date:_____________
Admissions Director: ____________________________________ Date:_____________
Accepted Date: ___________________________________________________________
Program: ________________________________________________________________
