Tuition Benefits Form
*This portion is to be completed by parent/employee*
Employee Information
Employee Name: ___________________________________
Student Information
Dependent Name: ____________________________
Last 4 digits of SS #:
_________________________
Last 4 digits o
f SS #: ________________________________
Date of Birth: ____________________________ Full Address: ______________________________________
(mo./da./yr.)
Class Year for Tuition Benefit:____________________ ___________________________________________
(Freshman, Sophomore, etc.)
Home Telephone: __________________________________
Work Telephone: _______
____________________________
Anticipated College Graduation Date: ______________
Academic Year for Tuition Benefit: ________________
Academic Term: Fall Spring Summer
Department: _______________________________________
Date Employed: ___________________________________
Employment Type: Faculty Staff
Student is m y: dependent
child legal guardianship
self
spouse/partner
Tuition Be
nefit Options (check all that apply):
Furman University Tuition Benefit (students enrolling into Furman Undergraduate or Graduate Programs)
*Tuition Scholarship Grant: _________________________________________________________________________
(Name of Tuition Scholarship Grant institution – not used by FU or tuition exchange students)
Associated Colleges of the South Exchange: __________________________________________________________
(Names of ACS institution(s) applying to)
Tuition Exchange, Inc.: ____________________________________________________________________________
(Names of TE institution(s) applying to)
*Job-Related Tuition Reimbursement
Signature of Employee: ________________________________________ Date: ____________________________
*
Human Resources Verification*
__________________________________
_______ _________________________________________
HR Signature Date
Eligible Not Eligible
Verify the following:
Employee has two years continuous service starting September 1, 2011
D Dependent is child, legal guardianship, spouse/partner
Child is under age 24
FURMAN UNIVERSITY, Human Resources Department, 3300 Poinsett Highway, Greenville, SC 29613
(864) 294-2217 / (864) 294-3678 – FAX
Dependent Email: ________________
_____________
*Form must be completed each semester for Tuition Scholarship Grant and Job-Related Tuition Reimbursement
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