TUITION WAIVER AUTHORIZATION
Any eligible employee, spouse, domestic partner, dependent, or retiree seeking the tuition waiver
MUST fill out this form.
*This request for waiver is for … (Mark One):
___ Employee (Self)
___ Spouse
___ Retiree/Retiree Spouse
___ Domestic Partner**
___ Dependent Child (to age 25)
STUDENT or RETIREE INFORMATION:
Student / Retiree Name ________________________________ Term _______________
COCC ID (820#) _______________________________
DO
B ________________
(Dependent children only)
COCC EMPLOYEE INFORMATION:
Classified ___ Administrative ___ FT Faculty ___ ABS ___ Adjunct Faculty ___
Employee Name (printed): __________________
___________
COCC ID (820#) __________________ Work Department: ________________________
Date of Employment: _______________ Full Time ___ Part Time ___
POLICY REMINDER:
By signing this authorization, the staff member acknowledges and accepts the policies
and procedures stated in the Staff Tuition Waiver Policy (available online at /Employee
Login/HR Forms/Employee Related Forms/Staff Tuition Waiver Policy):
E
mployee / Retiree Signature ___________________________________________
* Tuition waiver forms MUST be submitted EACH term by the tuition due date to avoid late
payment fees. All late payment fees incurred are the responsibility of the student. Submit this
form to the Cashier’s office in the Boyle Education Center.
Tuition waiver forms WILL NOT be accepted after the last day of the term in which the
coursework was taken. If a tuition waiver form is not submitted by this deadline, all tuition and
fees become the full responsibility of the student.
** Tuition waivers are a taxable benefit for domestic partners and domestic partner dependents.
As such, they will be added to your taxable income as the waivers are incurred. The Domestic
Partner relationship must be documented (Affidavit must be on File with Human Resources for
eligibility).
Classified staff members must be in Regular Status (initial probationary period completed) by
the tuition payment due date of the term for which the waiver is applicable.
If you have questions about eligibility, please call HR at 541-383-7216.
Rev APR2016
