Civil Service Retired Employee Tuition Waiver Application

Civil Service Retired Employee Tuition Waiver Application
Retired Employee Name*

First NameLast Name
Retired Employee ID*
Retired Employee Email*
example@example.com
Date of Retirement*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Class Information
Semester*
Year*
Course Information*
Tuition and fees waiver will be issued only when this form is submitted to Human Resources prior to registration for classes. Retired employees not in compliance will be responsible for full payment of tuition and fees (see tuition waiver guidelines). Application for admission and class registration are the responsibilities of the retired 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.
Employee Signature

Clear
Should be Empty:

Class Information