Tuition Waiver

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Tuition Waiver Application

APSCUF / OPEIU Healthcare / Management

Complete a separate form for each person who will be taking courses.

Employee Information

Do you have active SRU account credentials?

Yes

Please sign in with your SRU account. You will be brought back to this form once you have signed in.

Full name

Waiver Details

Term

I am applying for the tuition waiver for:

Myself

My spouse

My child

Bargaining unit of employee:

APSCUF / Coaches

Management

Are you retired?

Yes

Only a retiree may complete this form without an SRU account. If you are a current employee, please sign in above.

A retiree may apply for the tuition waiver for a child only. "My child" has been selected above.

Years of PASSHE service

Date of retirement

Age at retirement

Person Taking Courses

Name

SRU ID #

Child's birth date

Was your child claimed as an exemption on your recent Federal Income Tax Return?

Yes

If not claimed, please explain

My spouse or child, named above, has earned the degree(s) checked below:

Has not earned a college degree

Associate Degree

Associate Degree from

Bachelor's Degree

Bachelor's Degree from

Master's Degree

Master's Degree from

Courses to be taken are:

Graduate level

Undergraduate level

Courses

I am requesting the tuition waiver for the following course(s). Up to two courses may be entered.

Course 1

Course title

# of credits

Course 1: Is this course online and taken outside of business hours?

Include self-paced courses with no set meeting times.

Yes

Days class meets

MMonday TTuesday WWednesday TRThursday FFriday SSaturday USunday

Meets from

Meets to

Course 2 - Optional

Course title

# of credits

Course 2: Is this course online and taken outside of business hours?

Include self-paced courses with no set meeting times.

Yes

Days class meets

MMonday TTuesday WWednesday TRThursday FFriday SSaturday USunday

Meets from

Meets to

Are you taking any classes during work hours?

Yes

Classes during work hours need approval from your Supervisor, Dean/Director, Vice President and President. To select them you must sign in with your SRU account.

By submitting, I certify that I have read the attached tuition waiver information. I also certify that I am eligible to apply for this waiver and that I am currently a full-time employee in compensable status.

By submitting, I certify that I have read the applicable information and that I am eligible to apply for this waiver.

Once this form has been processed, all users involved will receive a copy via email.

Incorrectly filled fields may require form resubmission.

***All fields are required unless otherwise marked with: - Optional***

If you have any issues completing this form, please contact Human Resources.

Please verify your information

These answers are written onto the form for you and cannot be changed in DocuSign. Please confirm the information below is correct.