Application for Tuition Remission

Application for Tuition Remission
Tuition Year
Tuition Term
Student Name Student Name First Middle Last
Student Date of Birth Student Date of Birth / MM / DD YYYY
Student CBU ID
Must be 9 digits. Currently Entered: 0 digits.
Employee Name Employee Name First Middle Last
Employee Hire Date Employee Hire Date / MM / DD YYYY
Employee CBU ID
Must be 9 digits. Currently Entered: 0 digits.
Employee Phone Employee Phone - ### - ### ####
Employee CBU Email
Eligibility:

Eligibility: Employee Dependent Spouse Graduate Assistant Tuition Exchange International Exchange
Percentage Eligibility

Percentage Eligibility 100% 50%
Clasification

Clasification Day Evening / Global College
Program

Program Undergraduate Graduate
Grad Degree Program
Campus Resident?

Campus Resident? Yes No
Number of Credit Hours
Must be a number greater than or equal to 1.
CBU Manager/Supervisor Name CBU Manager/Supervisor Name First Last
CBU Manager/Supervisor Email
I hereby signify my understanding of CBU’s Tuition Remission Policy, as stated in Section 3.4.2 of the Personnel Handbook. I acknowledge that I am responsible for all fees and I must settle my account with the Business Office prior to the first day of classes. To receive remission benefit in successive terms of the academic year, I must submit an “Application for Tuition Remission” form upon registration for each term. To be considered for eligibility, I must first file a FAFSA application at www.fafsa.gov if I am enrolling in six (6) or more credit hours of undergraduate courses during a term. This form is must be submitted seven (7) days before the settle date of each semester or term.

Please contact Human Resources Office at (901)321-3307 if you add or drop any classes after your Application for Tuition Remission has been approved.
EMPLOYEE SIGNATURE (type your name)
Your typed name indicates that you have read and understand the Tuition Remission Policy and agree to the terms.
Signature Date Signature Date / MM / DD YYYY