Position Title: _________________________________
Phone Number: ______________________________
Department Where Employed:
Signature of Employee: ____________________________________________________
I approve and certify that this employee is employed full-time.
Signature of Supervisor/Chair: ________________________________________ Date: ____________________
Signature of Dean or CFO or Vice Chancellor (if applicable): _______________ Date: ____________________
Signature of Chancellor: ______________________________________________ Date: ____________________
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Louisiana Delta Community College
Office of Financial Aid
FACULTY/STAFF TUITION EXEMPTION REQUEST
Semester
SPRING SUMMER I SUMMER II FALL
Eligibility and Instructions:
The tuition exemption program is available to all full-time employees who have been employed at least one year in a
full-time permanent position and with approval from his or her supervisor and chancellor may register for job-related
undergraduate or graduate courses at any LCTCS System campus for up to six (6) hours per semester and receive a full
tuition exemption. YOU MAY ONLY TAKE ONE CLASS DURING YOUR REGULAR WORK SCHEDULE.
Not to exceed three clock hours per week. Courses must be taken for credit. Fees cannot be waived for audit class.
All fees required for enrollment, except for tuition, shall be paid by the employee.
Please complete form, collect all signatures and attach semester class schedule. Return request form to the Financial
Aid Office. A request form must be completed for each semester or summer session.
Employee
Status Faculty Professional Staff
Classified Staff
Course Registration
Please give full name of course and credit hours, days and time course is scheduled. If you make a change, please
submit a revised Fee Waiver Application.
Course Name Credit Hours Days Time
I will I will not attend class during my regular working hours.
DOCUMENTATION OF “JOB RELATED” EDUCATION
My program of study is job related. (If No, waiver is taxable and you DO NOT NEED to
complete the rest of this section.)
Yes No
For Office of Human Resource Use Only
This employee has met the service requirements for the fee exemption requested. Faculty Staff
Date Office of Human Resources Approving Agent
Course Name Credit Hours Days Time
