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ULM Employee Name (Last, First, MI) ULM ID Number LA Delta Campus Wide ID Number
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Degree being pursued Major
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ULM Employee Signature Date
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LADelta Vice Chancellor for Student Affairs Signature Date
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WAIVER APPLICATION FOR
LOUISIANA DELTA COMMUNITY COLLEGE TUITION BENEFIT
UNIVERSITY OF LOUISIANA AT MONROE EMPLOYEE
This form must be submitted for each semester in which the tuition benefit is requested. Submit a copy with original
signatures at least two weeks before LA Delta’s final bill payment date of the semester to:
Bursar’s Office
LA Delta Community College
7500 Millhaven Road
Monroe, LA 71203
Bill payment dates are available at LA Delta’s website: www.ladelta.edu
Please type or print all information.
Select Session/Semester Attending: FALL SPRING SUMMER (A, B or C)
WINTER SESSION
Subject and Course Number Credit Hours Year Campus/Location
1. The following conditions apply to ULM employees who seek the La Delta tuition benefit below. The employee must:
a. Be a degree seeking student at La Delta
b. Be employed on a full-time at ULM
c. Submit an application for admission to La Delta and pay the appropriate application fee(s)
d. Meet admission requirements for LA Delta
e. Adhere to La Delta policies and procedures
f. Submit a signed and completed copy of this form for each semester in which the benefit is requested
2. ULM employees who meet all requirements listed above may register at La Delta for:
a. Up to six credit hours per term in undergraduate courses at a rate of $25.00 per credit hour; or
b. Up to six credit hours per term in graduate courses at a rate of $50.00 per credit hour
3. ULM employees who enroll in La Delta courses under this program must pay the academic excellence fee, operational
fee, and student technology fee, which shall be prorated for part time enrollees.
4. The tuition benefit shall apply only to courses and programs not available at ULM and for which regular tuition is charged.
5. Courses must be taken for credit; fees will not be waived for audit classes.
6. The tuition benefit may not be used in combination with any other discounted program.
7. ULM employee account balances must be paid in full each semester.
I certify that I meet all of the criteria and agree to the terms specified above.
I certify that the above individual is/will be a fulltime employee of ULM during the semester for which the tuition
benefit is requested
