Fillable Tuition Remission/Exchange Request Form for Dependents (Elizabethtown College)

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Tuition Remission/Exchange Request Form for Dependents (Elizabethtown College)

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The Tuition Remission/Exchange Request Form for Dependents (Elizabethtown College) form is 1 page long and contains:

  • 2 signatures
  • 8 check-boxes
  • 46 other fields

Country of origin: US
File type: PDF

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Tuition Remission/Exchange Request Form for Dependents
This form must be completed after the dependent has applied for admission to the corresponding school(s) and submitted to HR prior to the start
of any semester in which remission is requested OR prior to the start of any academic year in which TE or CIC is requested. The tuition remission
section of this form must be completed for dependents that have applied or plan to apply to Elizabethtown College, even if TE or CIC is also being
requested. Please send the completed form to HR (hr@etown.edu
).
Employee Information
Name:
ID #:
E-mail:
Phone:
Address:
City:
State:
Zip:
Full-time Hire Date:
Dept:
*Part-time employees are not eligible for this benefit
Dependent Information
Name:
E-mail:
Date of birth:
Last 4 digits of SS#:
Student’s year (i.e. first yr, soph, grad yr):
Student’s major:
Please read the following policy requirements and check the appropriate box.
The student is claimed as my dependent (per IRS regulations). ☐Yes ☐No
The student is unmarried. ☐Yes ☐No
The student is my naturally born or legally adopted child. ☐Yes ☐No
The student is under the age of 26. ☐Yes ☐No
The student is in good academic and social standing. ☐Yes ☐No
The student has registered/applied for the upcoming semester. ☐Yes ☐No
Tuition Remission for undergraduate education (attending E-town College)
Semester and Year:
Is this for a study abroad semester?* ☐Yes ☐No
*Study abroad must be a requirement of the major in order to use tuition benefits
Tuition Exchange and Council of Independent Colleges
Tuition Exchange (TE) / www.tuitionexchange.org
Council of Independent Colleges (CIC) / www.cic.edu
Academic Year:
Academic Year:
☐ Renewal for TE School:
☐Renewal for CIC School:
☐ New request for TE (complete below)
☐New request for CIC (complete below)
School(s) to which student would like to apply for TE (attach or
list additional schools on the back of this form if necessary)
School(s) to which student would like to apply for CIC (attach or
list additional schools on the back of this form if necessary)
1.
1.
2.
2.
3.
3.
4.
4.
My signature provides authorization for my dependent’s course grades to be released to Human Resources. My signature also
signifies that I am aware of the full policy which can be found in the Employee and Faculty handbooks.
Employee’s Signature:
Date:
This section to be completed by Human Resources
☐Approved ☐Disapproved
Notes:
Signature of HR representative:
Date:
Cc: Requesting employee, Tuition Exchange Officer, Financial Aid, Business Department
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Tuition RemissionExchange Request Form for Dependents (Elizabethtown College)

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Completed 20 August 2020

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