Request for Faculty/Staff Tuition Waiver
THIS FORM MUST BE COMPLETED AND APPROVED PRIOR TO PAYMENT OF CHARGES
Board of Regents Policy 940.13 allows units of the Montana University System to grant waivers of tuition to permanent employees
who are employed at least .75 FTE during the entire period of enrollment, when they are enrolled in credit courses. The
authorized waiver for faculty and staff is limited to 6 credits per semester, per MSU-Northern policy 804.2.
Name _______________________________________ Banner ID# ___________________________________
Title and Department ________________________________________________________________________
Campus _____________________________________ Phone # ____________________ Faculty
Staff
Semester Spring
Fall Summer Academic Year _____________
Course # Credits Course Description Time Days
____________ _____________ _______________________________________ ____________ ____________
____________ _____________ _______________________________________ ____________ ____________
____________ _____________ _______________________________________ ____________ ____________
Total Credits _________
I understand that the value of the faculty/staff tuition waiver is taxable income if my admission status is graduate degree or graduate non-degree. The
applicable taxes will be deducted from my payroll earnings. I hereby authorize the University Payroll Office to withhold from my final paycheck the value of
this tuition waiver in the event I terminate my employment with the University prior to completion of the course(s) for which I have been granted the waiver.
Employee Signature ________________________________________________ Date _____________________
Supervisor signature indicates that the employee has satisfactorily rescheduled any time missed from work.
Supervisor Signature ________________________________________________ Date ____________________
Employment Certification
Employee FTE on Date of Registration ______________
If request is for Summer Session: FTE appointment preceding year ________FTE appointment succeeding year _________
Director of Human Resources Signature__________________________________ Date ____________________
If employed by a Montana University System campus other than MSU-Northern
Signature _________________________________________________________ Date ____________________
Employing campus Human Resourcse/Personnel Representative
