TUITION REMISSION AUTHORIZATION FORM

TUITION REMISSION AUTHORIZATION FORM
Admissions process completed? Yes No
Return this completed form to Human Resource Services by the last day of regular registration (not late
registration).
Name: last, first (please print)
EMPLOYEE INFORMATION
Name: last, first (please print)
STUDENT INFORMATION
_________________________________________________________ _____________________________________________________
Department or office:
Normal working hours:
Date of hire:
MU ID Number:
Relationship to employee: MU ID Number:
Self Spouse
Dependent Child
Non-Dependent Child
Child tax status (if benefit is for child):
New registration: credits
Dropping: credits Adding: credits
Requested by:
(Signature)
Yes (student is claimed as dependent for tax purposes)
No (student is not claimed as dependent for tax purposes)
Program:
Program:
Undergraduate
Full-time
Graduate
Part-time
Date:
Term: _____
Year: _____
AUTHORIZATION
Classes scheduled during work hours (Y/N)? ________
Plan for make up time approved (Y/N)?
Department supervisor name (please print)
_______________________________________________________
Department supervisor signature
_______________________________________________________
Vice President Signature
Date
___________________________________
Date
Date
Do not write below line, for official use only
y:
HR SERVICES
REGISTRAR
STUDENT ACCOUNTS
Number of credit hours authorized
for remission:
Number of credit hours to be taken:
Invoice number
Amount
Tuition rate:
Full tuition credit
% discount: _______
Tuition is subject to applicable
taxes if the tuition is for a
non-dependent child.
Tuition amt. subject to taxes: $_______
Received by: Initial Date
Financial Aid ________ ________ TAG _______ FAF _______
HR Services ________ ________
Registrar ________ ________
Student Accounts ________ ________
10/2001

INSTRUCTIONS FOR COMPLETING AND PROCESSING
THE TUITION REMISSION AUTHORIZATION FORM
STEP 1 Employee:
1 . You must complete the Admissions process before applying for this benefit.
2 . Obtain a Tuition Remission Authorization Form from the Human Resource Services Office.
3 . Complete all the information on the reverse side of this form.
4 . Employees’ spouses and dependent children who intend to study full-time must apply for
federal and state financial aid through the usual Financial Aid process. Visit the Financial
Aid Office for additional information.
STEP 2 Supervisor:
1 . Verify that the employee has been employed for the required amount of time and meets all
the requirements in the appropriate Employment Manual.
2 . Authorize the form and make a copy for your records.
STEP 3 Employee:
Return this completed form to the Human Resource Services Office by the last day of
regular registration (not late registration).
STEP 4 Human Resource Services Office:
1 . Verify that the required waiting period has been met and record the number of credits authorized
for tuition remission.
2 . Determine if the tuition remission is subject to applicable taxes. Employees’ whose children
are not dependents for tax purposes are subject to taxes. Make an additional copy of the
Tuition remission forms that need to be taxed and submit the copies to the Benefits Manager
for processing in the computer. Request from Student Accounts the amounts subject
to taxes.
3 . On the last day of regular registration (not late registration), take a copy of all tuition remission
forms to the Student Accounts Office.
4 . File original tuition remission forms in the Human Resource Services Office.
STEP 6
Read your employment manual for additional information about this employment benefit.
10/2001