University System of Georgia
EMPLOYEE APPLICATION FOR TUITION ASSISTANCE PROGRAM (TAP)
(Please Print)
Complete this application with all required approval signatures and submit by the required deadline to the TAP Coordinator at the Home Institution. This
application is subject to final approval by the TAP Coordinator of the Teaching Institution.
Tuition Assistance waives tuition and applicable student fees for credit courses at a USG institution.
Employee ID #
(ADP ID# if applicable)
-mail address:
Are you pursuing a
degree?
If yes, indicate your degree program (Associate, Bachelor,
etc.):
Area of discipline (e.g., Math,
Psychology):
Yes No
Are you eligible for a Hope Scholarship, Hope Grant, or Pell Grant?
Yes No
List Requested Course(s): The number of semester credit hours (maximum of nine) must be consistent with one’s institutional work commitment.
Note:
Employees may not enroll in certain programs or courses, including: dental, law, medical, pharmacy, veterinary, or executive/premiere or
comparable graduate school programs, workshops, seminars, continuing educ
ation courses, management development programs, special
examinations, or private consultant refresher courses to take examinations.
Immediate Supervisor Approval
Supervisor’s Name (Print):
I approve this request and certify that the employee’s participation will not adversely affect departmental services nor
cause undo hardship for other employees. If I am allowing the employee to attend classes during the workday, attached is
the alternate work arrangement.
I cannot approve or certify the employee’s request to attend classes because
TAP COORDINATOR APPROVALS
Home Institution TAP Coordinator Approval: Yes No
Home Institution TAP Coordinator Signature:
After approval by the Home Institution Tap Coordinator, this application must be forwarded to the Teaching Institution TAP
Coordinator
within 10 business days following the TAP application deadline).
Teaching Institution TAP Coordinator Approval:
Yes No
Institution TAP Coordinator Signature:
03/9/10 HMD
REQUESTED COURSES
Course Course Title (e.g., Elementary Statistics)
Course Name/Number (e.g., Math
1104)
CRN No.
Credit
Hours
Class Days & Times (e.g., T &
Th 1:30 – 2:45 pm)
1
2
3
Employee Certification: My signature below certifies that the information provided is accurate and truthful. I understand that I must register for courses only
during the employee registration period of the Teaching Institution I wish to attend. I also understand that I must receive a grade of “C” or better and provide a
copy of my grade report to the TAP Coordinator of the Home Institution upon completion of the course(s). Finally, I certify that I have read and agree to abide by
the policies and procedures of the TAP Program.
Employee Signature:
Date:
