ORANGE COUNTY COMMUNITY COLLEGE
MIDDLETOWN, NEW YORK
FACULTY AND STAFF & CHAIRMEN’S ASSOCIATIONS
ADJUNCT FACULTY
DEPENDENT/SPOUSE TUITION WAIVER
This form authorizes the waiver of tuition and fees for the dependent or spouse of Faculty or
Staff & Chairmen Association members and Adjunct Faculty. Present this form to the Bursar
office once authorized signatures are completed.
The student (dependent/spouse) must complete the admission requirement and be accepted
into a degree or certificate program. This waiver is for credit courses and associated fees, only.
Full time Day Adjunct Evening Adjunct
EMPLOYEE: ______________________________________________________________
STUDENT: ________________________________________________________________
RELATIONSHIP TO EMPLOYEE: ______________________________________________
SEMESTER: _______________________________________________________________
For Adjunct Faculty: This form authorizes the waiver of tuition and fees on a pro-rated basis.
Example: If employee is teaching 12 credits/16 contact hours = 100% waiver
If employee is teaching 6 credits/ 8 contact hours = 50% waiver
If employee is teaching 3 credits/ 4 contact hours = 25% waiver
HOW MANY CREDITS ARE YOU TEACHING? WHAT SEMESTER ARE YOU TEACHING?
______________________________________ ___________________________________
SUBMIT THIS FORM TO THE HUMAN RESOURCES OFFICE FOR AUTHORIZATION
AUTHORIZED:
Approved for ___________________________% Waiver
Human Resource Officer:_______________________ Date:__________________
Admissions Director:___________________________ Date:_________________
Accepted Date:_______________________________________________________
Program:___________________________________________________________
