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BURSAR OFFICE
Request for Approval of Class Attendance/Fee Remission
Administrative / Professional / Faculty / Clerical / Service
Bursar Office Form 1001 Revised 06/21/16 PLEASE PRINT CLEARLY
ALL FORMS MUST BE COMPLETED IN FULL IN ORDER TO BE PROCESSED. INCOMPLETE FORMS WILL BE RETURNED TO STAFF
MEMBER. (NEW FORM REQUIRED FOR EACH TERM.)
NAME: ___________________________________________________
DEPARTMENT NAME: _____________________________________
HIRE DATE: ______________________________________________
CAMPUS PHONE: _________________________________________
FOR: Fall___20______ Spring___20______ Summer___20______
(Check the semester and indicate the year.)
Schedule Subject &
Days/Hrs Course#
TOTAL CREDIT HOURS
Credit
Hours
STUDENT ID NUMBER: _____________________________________
EMPLOYING CAMPUS: _____________________________________
ELIGIBLE STAFF: (Please check one.)
___ ADMINISTRATIVE / PROFESSIONAL / FACULTY
___ CLERICAL / SERVICE
___ OFFICIAL RETIREE
Hours absent from work each week will be made up as follows:
Please explain your rationale if you are requesting an exception to the credit hour limitation (seven [7] credit hours per semester and
four [4] credit hours per summer session:___________________________________________________________________________
Requested: ____________________________________ _________________________________
Employee Signature Date
I do support and certify that enrollment in these courses will not negatively impact the employee’s work performance.
Department Head Signature (REQUIRED) Date Supervisor Signature Date
I hearby certify that the person listed above is eligible for a staff fee remission in accordance with Executive Memorandum C-7.
(See back for University Policy.)
Human Resources Signature Date
======================================POLICY EXCEPTION=======================================
Approved Not Approved
(See back for University Policy.) Employee’s Vice Chancellor (or designee) Date
After all signatures, send to Bursar’s Office.
Bursar Office Use Only: Date Entered ____________Initials____________
Hammond Campus
2200 169
th
StreetHammond, IN 46323
(219) 989-2560 bursar@pnw.edu
Westville Campus
1401 S. U.S. Hwy. 421 Westville, IN 46391
(219) 785-5338 bursar@pnw.edu
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STAFF FEE REMISSION POLICY
Please refer to Executive Memorandum No. C-7
Eligible staff registered in Purdue credit courses offered by any of Purdue’s campuses are eligible for
a partial remission of fees and will be assessed the staff rate approve annually by the Board of Trustees.
Eligible staff include:
Faculty, administrative and professional, regular clerical and service staff employed half time
or more for a period of time which is expected to continue for more than a year.
Eligible staff, as defined in (a) above, on approved leave of absence.
Retired staff as defined in Executive Memorandum No. B-35.
Disabled staff receiving benefits from one of the University’s disability programs.
Adjunct faculty and associate staff as defined in Executive Memorandum No. C-12.
The staff rate will apply to credit courses offered during the fall and spring semester, summer period,
evening credit classes, credit extension classes, and summer intensive credit classes subject to the
following conditions:
The staff appointment must have been in effect during the first six weeks of a semester, on or before
July 1 of the summer period.
With the approval of the employing department head, eligible staff may enroll for seven credit hours per
semester and four credit hours during the summer session. Exceptions to the seven and four credit hour
limitations must be approved in advance by the employing department head and Vice Chancellor or
designee. The Vice Chancellor for Finance and Administration has delegated authority to his direct
reports for their departments.
The staff rate shall apply for a maximum of seven credit hours per semester and four credit hours for the
summer session. In addition, staff will be charged all applicable special fees, composite fees, lab fees,
deposits, workshop fees and differential fees. Staff authorized to enroll for more that the semester and
summer session limitations shall be assessed the full credit hour fee and other mandatory fees assessed
for each additional credit hour in excess of the maximums.
If a staff appointment terminates within six weeks after the start of a semester or prior to July 1
during the summer session, and course work is continued, full fees will be assessed for the semester
or summer session.
Staff, as defined in 1.(a) through 1.(e), may register as visitors without the payment of mandatory or
designated fees and receive no credit for course work, subject to these conditions:
The maximum number of hours is seven hours per semester and four hours during the summer session.
Enrollment as a visitor requires the approval of his/her department head and the course instructor.
Staff will be charged all applicable special fees, composite fees, lab fees, deposits, workshop fees or
differential fees established for the course or program.
No fees will be charged to staff who register for a course at the request of his/her supervisor for the
purpose of job training and who do not receive academic credit for the course.
This remission may be treated as a taxable benefit based on Internal Revenue Code.
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