HR Grant-In-Aid Application

Dependent of Emeritus, Retiree, or Deceased Professional Staff OnlyDistinguished Classified OnlyRetired or Emeritus Professional Staff Only
Employee Information
Employee Name:*

First NameLast Name
Employee ID:*
NSHE ID:*
Email Address:*
example@tmcc.edu
Employee Grant-In-Aid Information
Institution:*
Year Attending:*
FallSpring (includes Winter)Summer-MiniSummer-FirstSummer-Second
Employee Course Information
Number of Credits:*
UndergraduateGraduate
Eligible Dependent Grant-In-Aid Information
Spouse/Domestic PartnerFinancially Dependent Child
Dependent Name:*

First NameLast Name
Dependent Date of Birth:*
NSHE ID of Dependent:*
Dependent Institution Attending:*
Dependent Year Attending:*
FallSpring (includes Winter)Summer-MiniSummer-FirstSummer-Second
Dependent Number of Credits:*
UndergraduateGraduate
Additional Course Information
Course #1:*
Credits #1:*
MTWThFS
Course Time #1:*
Course #2:
Credits #2:
MTWThFS
Course Time #2:
I attest that the above named dependent student meets the Board of Regents' definition of "financially dependent child" as a natural, adopted or stepchild of a staff member or his/her domestic partner who is not financially independent, is claimed as an exemption for federal income tax purposes under the U.S. Internal revenue Code (26 U.S.C. 152), and has not attained the age of 24. If a dependent child is over the age of 24 and has served on active duty in the United States Armed Forces, contact Human Resources.

OR

I attest that the above-named student is my spouse or domestic partner.
I agree with one of the dependent statements.
By pressing submit, I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct; that I have read all the qualifications above, as well as the excerpts from the Board of Regents Handbook; and that I am entitled to request Grant-in-Aid for the above-shown applicant. I understand that false representation in this certification may subject me to civil liability, disciplinary action up to and including termination, and referral to the Nevada Attorney General for criminal investigation.
I agree with the stated terms and conditions.
Please verify that you are human:*
Sender Name:
Should be Empty:

Employee Information

Employee Grant-In-Aid Information

Employee Course Information

Eligible Dependent Grant-In-Aid Information

Additional Course Information