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Tuition Waiver Request Form (Variable Tuition)
Section 1: Employee Information
Employee Name:
*
Effective Date:
*
+
CX ID
*
Employee Email Address:
*
Classification:
*
Administration
Classified
Faculty (Full-Time)
Professional Support
Status:
*
Full time
Part time
Section 2: Recipient Information
Recipient name:
*
CX ID
*
D.O.B.
*
🛈
+
Recipient relationship to employee:
*
🛈
Self
Spouse
Dependent
Recipient relationship to employee: *Part-time employees dependents are not eligible for variable tuition.
*
🛈
Self
Semester:
*
Fall
Spring
Summer
Year:
*
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
*
Credit Hours:
*
Add another course?
*
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Add another course?2
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Add another course?3
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Add another course?4
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Add another course?5
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Add another course?6
Yes
No
Course Title and section:
*ICE Courses are not eligible for variable tuition
*Section Y courses are not eligible
Credit Hours:
Is this form ready to submit?
Yes
Section 2: Human Resources Use Only
Date Received:
+
HR Verified By:
Eligible?
Eligible for Benefit
Ineligible for Benefit
Comments:
Is this form ready to submit?
Yes
Section 3: Registrar Use Only
Date Received:
+
Registrar Verified By:
Comment:
Is this form ready to submit?
Yes
Section 4: Financial Aid Use Only
Date Received:
+
FinAid Processed By:
Date Processed:
+
Financial Aid processing complete?
Yes