Fillable Tuition Remission Employee Oct2013 (California Lutheran University)

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Tuition Remission Employee Oct2013 (California Lutheran University)

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Human Resources Department - 60 W Olsen Road #1100 - Thousand Oaks, CA 91360 - P: 805.493.3185 – F: 805.493.3655 Oct 2013
Application for Tuition Remission
Employee
Please complete entire form and return to the HR Department at least two weeks in advance of each semester or term. Incomplete forms will not be accepted.
EMPLOYEE (STUDENT) INFORMATION
EMPLOYEE’S LAST NAME
FIRST NAME
MIDDLE INITIAL
DATE OF HIRE
EMPLOYEE’S STREET ADDRESS
CITY
STATE
ZIP
EMPLOYEE’S EMAIL
CONTACT PHONE
APPLICATION INFORMATION
ANSWER ALL THAT APPLY TO THIS APPLICATION
Which program are you admitted to as a regular student?
If you are enrolling in an Undergraduate program, will you have…
Yes No
fewer than 140 units in the Traditional Undergraduate program (semester based)?
Yes No
fewer than 140 units in the Bachelor’s Degree for Professionals program (quarter based)?
Yes No
fewer than 36 units in the Fifth-year Credential program?
How many courses do you plan to attend for the current semester/term?
1 course
2 course
Other – Please explain:
PLEASE INDICATE YOUR REGISTRATION DETAILS FOR THIS APPLICATION
ACADEMIC YEAR:
TOTAL UNITS:
FALL
WINTER
SPRING
SUMMER
ONLINE TERM 1
ONLINE TERM 2
ONLINE TERM 3
ONLINE TERM 4
ONLINE TERM 5
PLEASE INDICATE YOUR CLASS STANDING FOR THIS TERM CHECKED ABOVE
FRESHMAN (0-29 UNITS)
SOPHOMORE (30-59 UNITS)
JUNIOR (60-89 UNITS)
SENIOR (90-124 UNITS)
5
TH
YEAR CREDITIAL
GRADUATE
SIGNATURE
To the best of my knowledge, I certify that the above information is true and correct.
SIGNATURE OF EMPLOYEE
DATE
SIGNATURE OF SUPERVISOR
(Required only for employee enrollment if class(es) are during regularly scheduled work hours)
DATE
Taxation of benefits offered under the Education Benefits Policy is determined by the Internal Revenue Code and is subject to change at any time.
For additional reference to the Educational Benefits policy please refer to the Employee Handbook (pages 34-39).
For HR office use only:
Eligible
Ineligible
FTE Status
Payroll Hours
Benefit
class(es) at
%
Ed.D applicant
HR Benefits Initials
Benefit
class(es) at
%
AVP of Human Resources Signature
Date
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Tuition Remission Employee Oct2013 (California Lutheran University)

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Completed 20 July 2020

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