Double Room Waiver for Children of WIU Employee

Double Room Waiver for Children of WIU Employee
Student Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
WIU ID*
Academic Year*
Semester*

FallSpring
Student Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Certification of Registration Compliance & Acknowledgement of Policies
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)
I hereby declare that I am a child, adopted or stepchild who is eligible for the double room waiver. I request and understand that this information will be verified by accessing university records, and that the double room waiver benefits granted to me may not exceed the semester limit established. 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 double room waiver benefits exceed the semester limitation, I will be responsible for the full value of any ineligible benefits that I may have received. Application of this double room waiver serves as both my official notification (unless denied) and my acceptance of this waiver. The refusal to accept this agreement will result in a forfeit of the waiver.
Signature*

Clear
Parental Disclosure/Certification of Illinois Public University Employment
Eligibility for the room waiver benefit is conditioned upon the parent being employed at 50% or greater as of the first day of the academic term for which the double room 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.
- Eligible child must be an admitted Western Illinois University student.
- Eligible child must be enrolled for at least 12-semester hours or more.
- Eligible child must maintain satisfactory academic progress, which will be verified by Financial Aid.
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 Office may formally confirm the employment record and/or parent/child relationship through the use of university employment/benefit records for which employment credit is claimed. Confirmation procedures may require additional documentation.
Qualified Employee (Parent) Name*

First NameLast Name
WIU ID*
WIU Email*
example@wiu.edu
Work Phone*
Please enter a valid phone number.
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.*

Clear
Limitations
- Subject to the eligibility requirements specified above, this double room waiver is limited to 8 regular semesters for students who utilize the waiver before AY 24 and 4 regular semesters for students who utilize the waiver AY 24 and after.
- The waiver is not applicable for summer term.
- The double room 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 double room waiver as specified above.
- Employment records of two parents cannot be combined with respect to the 50% or greater requirement above. 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.
- Employment status is evaluated as of the first day of the academic term.
- All scholarships are conditional upon continued availability of funding.
- Waiver cannot be combined with other room waivers or scholarships (i.e. Local Leatherneck Scholarship).
- Total double room waiver cannot exceed cost of room.
Process
- To ensure timely processing, the application should be received in Human Resources by August 28th for the fall semester and by January 28th for the spring semester. After the due date a finance charge of 1% of the account balance is added each month.
- Waiver will be credited to account after eligible student has registered for undergraduate classes and has a housing assignment.
Should be Empty:

Double Room Waiver for Children of WIU Employee

Student Certification of Registration Compliance & Acknowledgement of Policies

Parental Disclosure/Certification of Illinois Public University Employment

Limitations