Tuition Waiver Form

Tuition Waiver Form
Employee Email*
example@bankstreet.edu
Employee Name*

First NameLast Name
Reminder : You must submit a separate waiver form for each semester enrolled, at the beginning of each semester.
Do you perform teaching duties at Bank Street?*

YesNo
From the Employee Handbook and union contract: Assistant teachers shall have the right to enroll in four (4) free courses per academic year (September to August annually) provided that registration by staff members seeking to use their tuition allowance in courses beyond the first course that semester is limited to space available after completion of registration by all other students.

You must be an active and current employee of 50% load or more to receive tuition benefits or use a banked course. If you sign up for more than four free courses regardless of the number of credits, you will be responsible for the additional tuition payment. Student is responsible for paying any registration and materials fees. Student is responsible for full payment in the event that this form is not submitted timely. Requests must be submitted before the course begins. Assistant teachers may not roll over or bank courses.
All professional staff members who are appointed at 50% work load or greater shall have the right to enroll in two (2) free courses (not to exceed 12 credits) in the Graduate School or the Division of Continuing Education per academic year (September 1 through August 31). More than two (2) free courses are not permitted even if the total number of credits is below twelve (12) credits. Student is responsible for paying any registration and materials fees. Student is responsible for full payment in the event that this form is not submitted timely. Requests must be submitted before the course begins.

You must be an active and current employee to receive tuition benefits or use a banked course. Professional staff members may roll over one course for up to six months.
Employee Title*
Division*
Your Supervisor/Manager's Email Address*
example@bankstreet.edu

During which academic year do(es) your requested course(s) take place?*
The academic year begins September 1 and ends August 31
Please note: because this academic year has already closed, you may be required to submit additional documentation.
Have you already submitted a Tuition Waiver form for the selected academic year?*

NoYes
How many courses did you request on your previous form?
Courses to Take

Complete and submit this form during the registration period.
Course 1
1) Course Start Date*
1) Course Term*
1) Course Code*
1) Course Title*
1) Course Credits*
Course 2
2) Course Start Date
2) Course Term
2) Course Code
2) Course Title
2) Course Credits
Course 3
3) Course Start Date
3) Course Term
3) Course Code
3) Course Title
3) Course Credits
Course 4
4) Course Start Date
4) Course Term
4) Course Code
4) Course Title
4) Course Credits

Agreement
In accordance with IRS regulations, tuition assistance provided in excess of $5,250 in a calendar year is considered taxable compensation and is subject to withholding taxes. Accordingly, once this limit is reached, the excess will be included as earned compensation on your paystub with the appropriate taxes withheld ratably over the remaining course period(s).

I have read and agree with the information and terms on this form.
Employee Signature*

Clear
Date*

MonthDayYear
Date

1) Supervisor/Manager Approval

Please complete the Name and Signature fields in this section and Submit on the next page. This form will automatically be routed to HR for the next round of approval.
Supervisor/Manager Name

First NameLast Name
Supervisor/Manager Signature

Clear
Date

MonthDayYear
Date
2) HR Approval
HR Name

First NameLast Name
HR Signature

Clear
Date

MonthDayYear
Date
3) Financial Aid Processing
Has this request been processed by the Financial Aid Office?

Yes
Date

MonthDayYear
Date

Please submit your completed form below.
Should be Empty:

Tuition Waiver Form

Courses to Take

Agreement

1) Supervisor/Manager Approval

2) HR Approval

3) Financial Aid Processing