Interinstitutional 50% Tuition Waiver for Children of Public University Employee

Student Name*

First NameLast Name

Birthdate*

Date

Student University ID #*

Academic Year(s)*

Semester(s)*

FallSpringSummer

Student Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

University that student is attending*

Are you registered with Selective Service?*

Yes, I certify that I am registered with Selective Service.No, I am not registered with Selective Service

I certify that I am not required to be registered with Selective Service because*

I am femaleI was born before 1960I have not reached my 18th birthdayI am an international studentI am a permanent resident of the trust territory of the Pacific Islands or the Northern Mariana Islands.I am in the armed services on active duty (members of the Reserves and National Guard are not considered on active duty)

Have you previously used your 50% tuition waiver?*

Have not previously used tuition waiver at any schoolHave previously used tuition waiver, but only at Western Illinois UniversityHave previously used tuition waiver at another Illinois public university

Name of Institution where Previously/Currently Enrolled*

Academic terms during which the 50% tuition waiver benefit was utilized at another Illinois public university (specify total credit hours for which the 50% tuition waiver was applicable)*

I hereby declare that the Student Certification of Registration Compliance is true and correct and that I am a child, adopted or stepchild who is eligible for the 50% tuition waiver pursuant to P.A. 90-0282 and related policies/procedures. I request and understand that this information will be verified by accessing university records, and that total partial undergraduate tuition waiver benefits granted to me may not exceed the 4-year limitation established in P.A. 90-0282. In the event this application contains any false statements, errors or omissions pertaining to my parent's service record, or in the event total partial undergraduate tuition waiver benefits among eligible institutions exceed the 4-year limitation, I will be responsible for the full value of any ineligible benefits that I may have received.

I hereby declare that all previous or concurrent academic terms, during which the 50% tuition waiver benefit was utilized, are accurately accounted for above. I request and understand that this information may be verified by means of accessing university records and that the total partial undergraduate tuition waiver benefits granted to me may not exceed the 4-year limitation established in P.A. 90-0282. A Separate Tuition Waiver Benefit Utilization Record must be completed for each institution in which the student has been enrolled while utilizing tuition waiver benefits pursuant to P.A. 90-0282.

I understand that a separate Tuition Waiver Benefit Utilization Record must be completed for each institution in which I have been enrolled while utilizing these tuition waiver benefits, that the tuition waiver benefit utilization record may be subject to verification by the tuition waiver granting institution and that tuition waiver approval protocols shall be subject to individual university policies.

Application of this waiver serves as both my official notification (unless denied) and my acceptance of this waiver. As an applicant for or the recipient of a tuition waiver award form Western Illinois University, I understand that the University has the legal authority to release my name and address, the name of my former high school or college, the name of my award and the award amount. This release is valid for the period of time the tuition waiver is in effect. The refusal to accept this agreement will result in a forfeit of the waiver.

Signature*

At Western Illinois University, this tuition waiver is limited to 4 years, 8 regular semesters and 4 summer terms, or 120 hours, whichever comes first. If your child plans to attend another Illinois university, you may want to seek clarification on this limitation from their Human Resources office. If you have used the 50% Tuition Waiver during High School, this will count toward the 8 regular semesters.

Instructions: Please complete the following information as thoroughly as possible. All items must be completed. Percentage and dates of employment must be listed for each position claimed. The Human Resources or Personnel Office at listed universities may formally confirm the employment record and/or parent/child relationship through the use of university employment/benefit records at all locations for which employment credit is claimed. Confirmation procedures may require additional documentation. The employee must be employed at any Illinois public university for at least 7 cumulative years at 50% or more.

Qualified Employee (Parent) Name*

First NameLast Name

WIU ID*

WIU Email*

example@wiu.edu

Work Phone*

Please enter a valid phone number.

Employing University*

Category*

FacultyAdministrative/ProfessionalCivil Service

Name of University or Agency*

Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicable Employment History*

I hereby declare that this student is my child, adopted or stepchild. Employee signature is not required as a condition of student eligibility.*

Student Eligibility Requirements

PUBLIC ACT 90-0282

At Western Illinois University, this tuition waiver is limited to 4 years, 8 regular semesters and 4 summer terms, or 120 hours, whichever comes first. If your child plans to attend another Illinois university, you may want to seek clarification on this limitation from their Human Resources Office.
Eligibility for the 50% tuition waiver benefit is conditioned upon the parent being employed as of the first day of the academic term (in accordance with the academic calendar where the student is enrolled) for which the tuition waiver benefit would apply.
An eligible child of a qualified employee must be under the age of 25 at the commencement of the academic year during which the waiver is to be effective (in accordance with the academic calendar where the student is enrolled). Thereafter, the age limitation must continue to be fulfilled as of the beginning date of subsequent academic years.
The eligible child must qualify for admission under the same admission requirements, standards, and policies that the tuition waiver granting university generally applies to applicants for admission to its respective undergraduate colleges and programs.
The eligible child must continue to maintain satisfactory academic progress toward graduation in accordance with policies at the tuition waiver granting institution where the student is enrolled

Limitations

Subject to the eligibility requirements specified above, the waiver may be utilized until such time as a total of 4 years of undergraduate 50% tuition waiver benefits have been expended in accordance with university procedures utilized to calculate tuition waiver limitations generally. The 4-year limitation shall be comprised of the number of hours or semesters (including summer terms) necessary to complete an undergraduate degree as defined by the tuition waiver granting university, not to exceed a total equivalent period of 4 years. The 4-year limitation represents the cumulative total of partial undergraduate tuition waivers granted among all university locations where the entitlement may be exercised in accordance with P.A. 90-0282. In the event that a student who is eligible for the 50% tuition waiver transfers or simultaneously enrolls in another university (as defined above) the admitting institution shall receive, from the previous (or concurrent) institution, a certification defining the amount of 50% tuition waiver benefits that have been or are being utilized in accordance with the respective institutional standards for tuition waiver benefit calculations.
The tuition waiver benefit may not be used for non-credit or graduate/professional academic programs or certifications.
In the event a child loses eligibility through a parent's separation from employment during any given academic term or semester, the benefit shall not be rescinded for the duration of that term or semester. However, no future benefits may be extended until such time as the employee regains eligibility status.
If both parents are employees, an eligible child shall be eligible for a total maximum 50% waiver as specified above. Employment records of two parents cannot be combined with respect to the 7-year employment requirement. Eligibility criteria in terms of employment shall be benchmarked upon the employment record of only one parent, with the greatest individual amount of total university employment.
The waivers are available for attending Chicago State University, Eastern Illinois University, Governors State University, Illinois State University, Northeastern Illinois University, Northern Illinois University, Southern Illinois University, University of Illinois and Western Illinois University.
To ensure timely processing, the application should be received in Human Resources by August 28th for the fall semester, by January 28th for the spring semester, and by June 28th for the summer semester. After the due date a finance charge of 1% of the account balance is added each month.

Interinstitutional 50% Tuition Waiver for Children of Public University Employee

Student Certification of Registration Compliance & Acknowledgement of Policies

Parental Disclosure/Certification of Illinois Public University Employment

Student Eligibility Requirements

PUBLIC ACT 90-0282

Limitations