Tuition Grant Program Application printable pdf download

Tuition Grant Program Application

Employee Information

Name:

__________________________________________________________________________________

Address:

__________________________________________________________________________________

Date of Hire:

________________

Department & Position:____________________________________________

Have you been employed by the College less than five years, but were eligible for a similar program with your previous employer

at the time you accepted employment with Swarthmore College? □ Yes □ No

If Yes, please list previous employer and provide official documentation from your prior employer of the amount:

__________________________________________________________________________________

Dependent Information

Your dependent is your legally dependent child or stepchild who is a full-time undergraduate student at an accredited college, university,

junior college or post-secondary accredited technical school.

Name:

__________________________________________________________________________________

Address:

__________________________________________________________________________________

Date of Birth:

______________________________ Student ID#:________________________________________

Relationship to Employee: __________________________________________________________________________

□

Have you previously received a Tuition Grant from Swarthmore College?

Yes

If yes, indicate the academic years and number of semesters: _____________________________________________

Academic Information

Name of Institution Attending:_______________________________

Telephone #: ________________________

Address:

__________________________________________________________________________________

Please check the appropriate box:

□

Technical School

College/University

Junior College

You must attach a copy of the academic institution’s invoice to complete this application for a Tuition Grant from Swarthmore College.

Funds provided from the Tuition Grant Program may only be used toward the cost of tuition and fees for undergraduate studies and are sent

directly to the institution. It does not include expenses for room and board or books.

Human Resources Use Only

□

This employee is:

full time

part time

This employee has 5 or more years of continuous service: □ Yes □ No

*Fund: 12000*

Org: _____________

Account: _____________

SUMMER SEMESTER:

The dependent qualifies for the following Tuition Grant Amount: ______________________________

Approved by: ____________________________________________________ Date: ___________________________________

FALL SEMESTER

The dependent qualifies for the following Tuition Grant Amount: ______________________________

Approved by: ____________________________________________________ Date: ___________________________________

WINTER SEMESTER:

The dependent qualifies for the following Tuition Grant Amount: ______________________________

Approved by: ____________________________________________________ Date: ___________________________________

SPRING SEMESTER:

The dependent qualifies for the following Tuition Grant Amount: ______________________________

Approved by: ____________________________________________________ Date: ___________________________________

Tuition Grant Program Application

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