THE ALABAMA COLLEGE SYSTEM
 EMPLOYEES' AND DEPENDENTS' TUITION WAIVER APPLICATION

EMPLOYEE
Employee's Name_____________________________SSN__________________________

Dependent's Name____________________________SSN__________________________

Relationship to Employee    (   )Spouse    (   )Unmarried Child    (   )Unmarried Step-Child

Does the Dependent live with you? (   ) Yes   (   ) No    Your former spouse? (   )   (   ) No
Institution to Attend __________________________

Employee's Position/Title_______________________                                 Term ____________

Reference # ___________   Course# __________________________  Time _____________   Credit Hrs. _______

Reference # ___________   Course# __________________________  Time _____________   Credit Hrs. _______

Reference # ___________   Course# __________________________  Time _____________   Credit Hrs. _______

Reference # ___________   Course# __________________________  Time _____________   Credit Hrs. _______

Reference # ___________   Course# __________________________  Time _____________   Credit Hrs. _______
Courses changed after Financial Aid Office certification must be approved by the Financial Aid Office .

_____________________________________                               ___________________________________
Employee's Signature                                     Date                                                 Supervisor's Signature                          Date

*****************

Employer   ___________________________________________________________                                                             
                                      College                                   Contact Phone Number (If not WSCC-Hanceville)

FINANCIAL AID OFFICE
I certify that the above employee/dependent has maintained a 2.0 GPA and has not previously registered for this class.                                                                                                                                                ___________________________                                                                                                                                                 Financial Aid Officer           Date

BUSINESS OFFICE
Full-time Employment Date:_____________________                                              Percent of Tuition Waiver:_______

Account Number:_______________                                                                         ___________________________
                                                                                                                            Business Manager         Date
PRESIDENT'S OFFICE
I hereby certify that the above named employee is an eligible employee of the Alabama College System and is entitled to receive all benefits granted under the Employees' and Dependents' Tuition Waiver Program.

 Amount Entered:_____________                                                                          ________________________
                 Code: _________                                                                            President             Date

STEPS IN COMPLETING THE EMPLOYEES'/DEPENDENTS' TUITION WAIVER

1.    Complete all information

2.    Complete Dependent information if requesting the tuition waiver for a spouse/dependent.

3.    Sign and date the request.

4.    Supervisor must sign and date the waiver.

5.    Financial Aid Office must verify prior courses and then the waiver will be forwarded to the Business      Manager.

6.    The Business Manager will forward the request to the President's Office for approval.

7.    When the tuition waiver has been approved the Financial Aid Office will enter the award in the computer.

8.    Any course changes after step 5 will require additional approval from the Financial Aid Office.

QUALIFICATIONS FOR RECEIVING THE TUITION WAIVER

1.    Must be a full-time employee.

2.    Must have completed one full year of service with Alabama community college system before the first day of class.

           One year of service will receive a 33% waiver.
           Two years of service will receive a 66% waiver.
           Three or more years of service will receive an 100% waiver.

3.    Employee or spouse/dependent must follow the same procedures as a non-tuition waiver student in regards 
       to hours taken each semester.

DEFINITIONS

Employee Dependent includes tuition waivers to the spouse of any full-time employee, the unmarried (never married), natural or adopted children of any full-time employee, residing in the household of the employee or the employee's  former spouse; the unmarried stepchildren of any full-time employee residing in the household of the employee.

Form Page   Updated 8 July, 2003