WILKES UNIVERSITY
Employee name___________________________________________________________
Home address____________________________________________________________
Date of hire______________________________________________________________
Email address____________________________________________________________
Dependent name__________________________________________________________
Dependent SSN___________________________________________________________
Anticipated first semester of enrollment________________________________________
First time attendee, in his/her first year? Yes No
If no, please provide the number of undergraduate credits completed thus far? ________
My child (check one):
_____ Is already attending college but not currently receiving a tuition benefit.
(List school child is attending:_________________________________________)
_____Is applying to schools now, for fall 201_ enrollment (complete the year).
List all institutions to which the student is applying: Institution's Application Deadline:
__________________________________________________________________________________________
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__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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____Isn’t going to college next fall, but will do so in:_____________________________
____Other (e.g., student has a benefit but plans to transfer).
Please Explain:________________________________________________________________
Useful websites
Tuition exchange participants: www.tuitionexchange.org
CIC participants: www.cic.edu
FAFSA: www.fafsa.ed.gov
College search: www.collegeboard.com
www.petersons.com
OFFICIAL USE ONLY
Date Received: Employment Eligible
APPLICATION FOR DEPENDENT TUITION BENEFITS UNDER TUITION EXCHANGE PROGRAMS (Note: To be used for new
applicant or for student transferring to a different institution ONLY)