Fillable Undergraduate Tuition Remission form for EMPLOYEES and SPOUSES (Elizabethtown College)

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Undergraduate Tuition Remission form for EMPLOYEES and SPOUSES (Elizabethtown College)

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The Undergraduate Tuition Remission form for EMPLOYEES and SPOUSES (Elizabethtown College) form is 1 page long and contains:

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

Country of origin: US
File type: PDF

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Undergraduate Tuition Remission form for EMPLOYEES and SPOUSES
This request form must be completed after the employee or spouse has applied for admission to Etown College
and submitted to Human Resources prior to the start of any semester in which remission is requested.
Send the completed form to HR (hr@etown.edu
).
Employee Information
Name:
ID #:
Email Address:
Phone:
Address:
City, State, ZIP
Status:
Full-time Part-time*
Full-Time Hire Date:
*part-time employees are not eligible for this benefit
This request is for: Employee Employee’s Spouse (please complete next section)
Spouse Information (only complete this section if the tuition remission request is for an employee’s spouse)
Name:
Last 4 digits of SS#:
Email Address:
Phone:
Is spouse attending: Part-time Full-time
If FT, spouse’s major:
Tuition Remission (for undergraduate education)
Semester and Year:
Is this for a study abroad semester?* Yes No
SCPS Session:
Course Name:
SCPS Session:
Course Name:
SCPS Session:
Course Name:
SCPS Session:
Course Name:
*Study abroad must be a requirement of the major in order to use tuition benefits
My signature provides authorization for my/my spouse’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:
I certify that the information contained in this form is true and accurate.
Approval (to be completed by Human Resources)
Approved
Disapproved
Reason for Disapproval:
$20 fee to be assessed for course: Yes No
Signature of HR representative:
Date:
Cc: Requesting Employee, Financial Aid, Business Office
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Undergraduate Tuition Remission form for EMPLOYEES and SPOUSES (Elizabethtown College)

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Completed 20 August 2020

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