Application For Faculty And Staff Tuition Waiver Form - The University Of North Carolina
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1
2APPLICATION FOR FACULTY AND STAFF TUITION WAIVER
THIS FORM IS FOR USE BY UNCG EMPLOYEES ONLY. Those employed at another institution, but attending UNCG,
should forward the completed and approved form of their employing institution.
NAME: _________________________________________________________ UNIVERSITY ID #: ____________________________
DEPARTMENT: ___________________________________________ POSITION/TITLE: ____________________________________
UNIVERSITY PHONE #: _____________________________________ ALTERNATE PHONE #: _______________________________
How long have you been employed at UNCG? ______________________________________________________________________
Is this course being taken at UNCG or another UNC system school ? (Please check the applicable box.)
Are you classified as an undergraduate or a graduate ? (Please check the applicable box.)
Are you classified as SHRA staff EHRA non‐faculty or EHRA faculty ? (Please check the applicable box.)
APPLICANT: I understand that I must apply for this benefit each term. I understand that I will be responsible for the full tuition
and fee cost of any additional course(s) not covered by the Tuition Waiver Program. I understand that withdrawal from a tuition‐
waived course(s) counts towards the three (3) waivers allotted per academic year.
APPLICANT’S SIGNATURE: ________________________________________________________ DATE: _______________________
TERM (Please fill in the applicable year): Fall 20_____ Spring 20_____ Summer 20_____
COURSE ID SECTION COURSE TITLE CREDIT HOURS
1. _____________ __________ _____________________________________________________ ____________
2. _____________ __________ _____________________________________________________ ____________
3. _____________ __________ _____________________________________________________ ____________
If your immediate supervisor and department head are the same, BOTH signatures are still required.
To be completed by the employing institution:
Enrollment tuition‐free in the course(s) identified above will not interfere with a conflict with the satisfactory performance of normal
employment obligations by the above‐named applicant.
SIGNATURE OF IMMEDIATE SUPERVISOR: ___________________________________________ DATE: _______________________
To be completed by responsible party for UNCG faculty and staff only:
This applicant has my permission to enroll in the above course(s). Arrangements have been made for the applicant to fulfill his/her
employment obligations. I certify that his/her appointment/employment meets the specifications on the back of this form.
SIGNATURE OF DEPARTMENT HEAD/DEAN: __________________________________________ DATE: _______________________
To be completed by the enrolling institution:
The above‐named applicant has been found academically eligible to enroll in the course(s) identified above. There is space available
for the above‐named applicant to enroll tuition‐free in the course(s) identified above.
SIGNATURE OF ENROLLING INSTITUTION: ___________________________________________ DATE: _______________________
NOTE: This completed form must be presented, by the applicant, to the Cashiers Office for SHRA staff and EHRA non‐faculty
OR to the Office of the Provost for EHRA faculty for processing.
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