Tuition Remission Form for a Graduate Degree
At Claremont Graduate University or Keck Graduate Institute
Employee Full Name: ______________________________________________________
Deadline: This form must be completed and submitted before the start of each semester/session for which the
benefit is requested. Failure to do so may result in ineligibility for the benefit. Summer sessions count towards the new
fiscal year benefit. A Taxability Determination Form must be completed at the start of a new graduate program of
study before this form is submitted.
Institution of Enrollment: ___________________________ Semester: __________ Year: 20_____ # of Units: __________
Are you receiving any financial assistance, such as a scholarship, fellowship, or other financial aid? (Note: some
forms of aid may reduce your Tuition Remission benefit eligibility amount.)
No Yes: Total Amount $ _______________________
I hereby apply for the tuition remission benefit for the semester and units indicated above. I understand and accept
that if I am not in “good academic standing” as defined by my institution of enrollment AND/OR I withdraw from
the course(s) for any reason or otherwise do not successfully complete the course(s) I will be responsible for the
payment of any and all tuition costs owed to the institution of enrollment. I further understand that this benefit is for
tuition costs only (continuing education fees, doctoral study fees, and any other fees are not covered by this
benefit).
Employee Signature: _______________________________________________ Date: ____/____/_____
Confirmation of Eligibility
The employee is eligible for the Pitzer College tuition remission benefit described above as follows:
Non-Taxable Taxable
Human Resources Officer: _________________________________________ Date: ____/____/_____
Verification of Successful Completion and Good Academic Standing
I verify that the above named student:
is is not: in “good standing” as defined by the institution of enrollment.
has successfully completed* _______ units for the __________ semester of 20 _____.
* A passing grade must be received.
Registrar’s Officer:_________________________________________ Date: ____/____/_____
Payment HR
Total Tuition Benefit Amount $ __________________
Payment Date: ____/____/_____ Processed by:________________________________________
Final Copies: Employee / Human Resources / Student Accounts TuitionRemissionForm_Graduate_061219.docx
Pitzer Account: CC67800 FD100, FN230, S0219 (Dependent) S0725 (Employee), Ledger 5800
CGU Account : CC20001 FD100 R0023 Ledger 1140
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Pitzer College
TUI TI ON RE MI SSIO N PO LI CY
Eligibility: All benefit-eligible employees in regular positions at Pitzer College who qualify under the
following guidelines, will be covered under this Tuition Reimbursement Plan. Staff in temporary positions,
and faculty in non-tenure track appointments are not eligible. Full-time employment for staff is defined
as working 12 months, 40 hours per week. Part-time is defined as any regular employment, less than 12
months but at least 20 hours per week, and excludes temporary or on-call status.
Full-Time Employee Coverage: After l2 months of full-time continuous employment at Pitzer College,
employees shall be eligible to receive: (a) full tuition support for up to four courses per academic year
(summer inclusive), when enrolled as degree candidates in good standing at Pitzer College; or (b) up
to two courses per academic year (summer inclusive), when enrolled as degree candidates at any one
of The Claremont Colleges.
Dependent Children of Full-Time Employees: After l2 months of full-time continuous employment at
Pitzer College, the dependent children of employees shall be eligible to receive half-tuition support,
not to exceed one-half the cost of Pitzer tuition, when enrolled as degree candidates in good
academic standing at any one of the undergraduate Claremont Colleges.
Class Attendance for Full-Time Employees: Full-time employees may be granted up to three hours
leave per week at the discretion of the employee's supervisor to attend classes conducted during
the traditional work hours of the College.
Part-Time Employee Coverage: After four years of continuous employment at Pitzer College, regular
part-time staff working at least 20 hours per week are eligible to receive full tuition support for up to four
courses per academic year (summer inclusive) at Pitzer College when enrolled as degree candidates
in good standing.
Dependent Children of Part-Time Employees: After four years of continuous employment at Pitzer
College, the dependent children of part-time employees shall be eligible to receive half-tuition
support, when enrolled as a degree candidates in good academic standing at Pitzer College.
Payments: Tuition reimbursement will be made to the student's account only upon successful
completion of coursework. It is the responsibility of the student and/or employee to submit an
application form to the Director of Human Resources at the beginning of each semester. Forms will be
forwarded to the College Registrar for verification of course completion at the end of each semester.
IMPORTANT NOTICE
Tuition is defined as such and may not be applied to any other expenses, such as room & board,
laboratory fees, doctoral study fees, continuing education fees, community fees, off campus fees, etc.
Auditing: With instructor approval, any Pitzer College employee may audit courses at any of The
Claremont Colleges.
Death Benefit: Half-tuition will be paid by Pitzer College for dependent children when enrolled at any
one of the undergraduate Claremont Colleges as degree candidates in good academic standing up
to five years from the date of death of any employee who has served the College for five or more years.
Where death occurs between two and five years, the College shall adjudicate the half tuition privilege.
Unpaid Leave Status: Employees on unpaid leave status are not normally eligible to receive tuition
reimbursement benefits for themselves during the period of their leave.