WIU 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.Format: (000) 000-0000.

Employee Work Schedule (Hours and Days)

I am a:

Please select all semesters you plan to attend during the current academic year. If you anticipate enrolling in more than one semester, be sure to select each applicable term. This will help ensure your tuition waiver is processed correctly for all planned enrollments.

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:

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

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

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

WIU Employee Tuition Waiver Application

Class Information