WVNCC FULL-TIME EMPLOYEE AND ELIGIBLE DEPENDENT
TUITION AND INSTITUTIONAL FEES WAIVER REQUEST FORM
Employee Name:
I am requesting a waiver for:
Employee
Approvals:
Denied
Chief HR Officer
To request an employee or employee eligible dependent tuition and institutional fee waiver,
complete the information below and submit the completed form to the HR Office.
A separate form is needed for each individual and each semester.
Approved
Work phone #
Dependent
Dependents Name:
Course NameCRN
Date
Birth Date
Date
Business Office Use Only
I certify the requested waiver has been
posted to the student account listed
above.
Relationship:
Yes
No
High School Student
Semester
Student ID#/#
GPA
Comments:
Return original to the Human
Resources Office.
7/17
Credit Hours
Employee's Signature:
I verify that all information listed above is accurate and true. By signing this waiver
request, I authorize the Human Resources Office the approval to review the student
records for the requested individual listed above for determining eligibility.
Print Form
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signature
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signature
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signature
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