Application for Spouse Tuition Remission

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Application for Spouse Tuition Remission

Instructions: This application should be initiated by the employee requesting tuition remission for a spouseeach fall and spring semester, summer term, and/or intersession term before the registration deadline for each semester/term. Once completed, this form is to be forward to the Human Resource Department, Kent Wyatt Hall 247.

Tuition remission is available for the regular academic sessions, summer school, and intersession terms. The Tuition Remission Program does not include laboratory fees, course materials, book allowances, or housing fees. Also excluded are non-credit correspondences courses, short courses, workshops, and institutes taught by the Division of Graduate and Continuing Education.

A University Committee has developed a new payment guide with an update payment process for course cancellation/purge. The payment for tuition and fees is now due before classes begin. By August 6, all payment must be received or a payment plan must be authorized or you will be purged from classes which means you are no longer enrolled in the classes.

This deadline is also applicable for the tuition remission process for faculty, staff, dependent children and spouses. All paperwork must be received in the Human Resources Office by August 5 to allow processing time before the official class cancellation on August 6. To be clear, any faculty/staff, dependent children or spouses enrolled in classes but have not completed the tuition remission paperwork, will have the class cancelled and will not be enrolled in the class.

If you have any questions, please contact Teresa Yarbrough in Human Resources at 4029 or .

Spouses of regular full-time employees are eligible to have tuition remitted up to six (6) undergraduate or graduate credit hours per fall or spring semester and up to three (3) credit hours per summer or intersession term with a maximum of eighteen (18) credit hours per fiscal year.

EMPLOYEE’S NAME

First

/ Middle / Last
900#
DEPARTMENT
DATE EMPLOYED
EMPLOYEE
CLASSIFICATION /  Full-time Part-time
SPOUSE’S NAME

First

/ Middle / Last
900# / DOB:
ADDRESS:
SEMESTER/TERM / Fall
Spring / Summer Term I
Summer Term II / Intersession (December)
Intersession (May)
Year:
CLASSIFICATION: / Undergraduate Student / Graduate Student / Doctorate Student
CRN NUMBER / COURSE DESIGNATION
(Example: MGT 200) / CREDIT HOURS
CRN NUMBER / COURSE DESIGNATION / CREDIT HOURS
CRN NUMBER / COURSE DESIGNATION / CREDIT HOURS

I certify that the person named above is my spouse. It is understood that should the status or the applicant change, I assume responsibility for notifying DeltaStateUniversity’s Human Resource Department.

Employee’s Signature / Date
Verified by: / Disapproved
HR Representative / Date Entered / Approved