Form Pr17 - Employee Tuition Waiver Request Page 2
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1
2PR17
RADFORD UNIVERSITY
(Rev.
06/13)
EMPLOYEE TUITION WAIVER REQUEST
Name
Email
RU ID#
Job Title
Department
Work phone
Request for
20
Fall
Wintermester
Spring
Maymester
Summer I
Summer II
Summer III
Course Reference
Course Abbreviation and Number (i.e., ACTG 203)
Number
Title
Class Schedule
Are you taking this course for credit? Yes
If yes, how many credits?
No
RU student status:
Undergraduate
Graduate
Non-Degree-Seeking
Name of degree program, if applicable:
If you are a non-degree-seeking employee taking a job-related graduate course, please explain job relatedness.
I request waiver of tuition for the above course and certify I have read, understand and qualify under the policy governing this request.
Signed _____________________________________________
Date ______________________
Employee
The scheduling of this course will not significantly interrupt or impede the normal work schedule of this department. This employee
has made up the time used to attend the last class which he/she took under this policy. I have discussed with this employee how he/she will
make up missed work time to attend class this semester. Furthermore, if this class is both graduate-level and job-related, the justification
which has been provided by the employee is appropriate. This employee has my approval to take this class.
Signed _____________________________________________
Date ______________________
Supervisor
Signed _____________________________________________
Date ______________________
Department Head
Disapproved
Approved
HUMAN RESOURCES USE ONLY
The faculty/staff member named in this request meets the qualifications for this tuition waiver.
Comments __________________________________________________________________________
Signed _____________________________________________
Date ______________________
Authorized Human Resources Official
*Cannot register for classes using tuition waiver until the first day of classes.*
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