Civil Service Employee Tuition Waiver Application

Civil Service Employee Tuition Waiver Application
Employee Name*

First NameLast Name
Employee ID*
Employee Email*
example@example.com
Employing Department*
Phone Number*
Please enter a valid phone number.
Employee Work Schedule (Hours and Days)*
Class Information
Semester*
Year*
List Courses*
Tuition and fees waiver will be issued only when this form is submitted to Human Resources prior to registration for classes. Employees not in compliance will be responsible for full payment of tuition and fees. Any credit hour taken over the maximum is the employee’s responsibility (see tuition waiver guidelines). Application for admission and class registration are the responsibilities of the employee.
I certify that I am:*

not required to be registered with the Selective Serviceam registered with the Selective Service
If you purposely state falsely any information relative to Selective Service registration, you may be subject to a fine or imprisonment or both.
Class Time

All classes will be taken outside of regularly scheduled work hours. (Supervisor signature not required for non-probationary employees.)Class(es) will be taken during the regular scheduled work hours and the time will be made up (limited to a maximum of 4 clock hours per week or the number of clock hours required to attend one course, whichever is greater.)
Supervisor Name

First NameLast Name
Supervisor Email
Please make sure this email is correct, otherwise your request could be delayed.
Work Hours Make Up Time*

Absence from work will be made up by working outside of regularly scheduled hours.Absence from work will be deducted from vacation.A combination of make up time and vacation will be used.
Please state how make up time will be accomplished. Please indicate days and time when lost time will be made up. Break time may not be used.
Employee Signature

Clear
Should be Empty:

Civil Service Employee Tuition Waiver Application

Class Information