Washington State Employee
Tuition Waiver Request
Eligibility & Regulations
To be eligible for the tuition waiver program, the participant must be employed as a permanent employee of the state of Washington
working half-time or more and be certied by their employer as eligible for the tuition exemption according to RCW 28B.15.558.
The waivers available to state employees under this section shall also be available to teachers and other certicated instructional staff
employed at public common and vocational schools, holding or seeking a valid endorsement and assignment in a state-identied shortage
area. The waivers available under this section shall also be available to classied staff employed at K-12 public schools when used for
coursework relevant to their work assignment.
Participants may register in person at Hawk Central on the rst day of the quarter, or the rst day of class, on space available basis and
may not overload a class. This form must be completed each quarter and must be presented at the time of registration. Participants
registering for class(es) without this form at the time of registration, or prior to the rst day of class, will be charged full fees and WILL
NOT qualify for the waiver for the current quarter.
The Tuition Waiver may not be used for self-support, contract or community education courses. It is valid only for state-supported courses.
Participants will pay a non-refundable registration fee of $5 per quarter, as well as all applicable course fees, lab fees, and other charges
as appropriate. All fees must be paid at the time of registration.
Grades will be posted to participant’s CBC transcript.
VALID FOR ONE QUARTER ONLY
Quarter and Year
Last Name First Name Middle Initial
Home Address City State Zip
Student ID Social Security Number (If applicable) Date of Birth Phone
Name of Agency/Department
Position Title How long in this position?
I have read the eligibility requirements and hereby request a tuition exemption as a permanent employee of the state of Washington.
Signature of Employee
TO BE COMPLETED BY EMPLOYEE’S HUMAN RESOURCES DEPARTMENT
I attest under penalty of perjury that this employee is a permanent employee of the state of Washington,
working at least half-time and is eligible to enroll under the tuition waiver program according to RCW 28B.15.558.
PRINT Name of Authorizing HR Employee Agency
Title Agency Mailing Address
Signature of Authorizing HR Employee City/State/Zip
Date Signed Phone Number
We are temporarily accepting this form via email while our campuses operate remotely. Please submit the completed form
to firstname.lastname@example.org no sooner than April 13th at 7 AM.
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the ba-
sis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military sta-
tus, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Ques-
tions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all college sponsored events and
programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
click to sign
click to edit
click to sign
click to edit