Board of Trustees of Community-Technical Colleges s1

Board of Regents for Higher Education, CT State Colleges & Universities

NORWALK COMMUNITY COLLEGE

EMPLOYEE TUITION/FEE WAIVER FORM

Application and Certification for Exemption from Payment of Tuition and/or Fees

(Waiver Guidelines for courses under Extended Studies on reverse side)

Name of Student:

Social Security # or

Student ID #:

Address:

ATTENDING: Community College

CERTIFICATE OF EMPLOYEE

Employee Name:

Address:

Bargaining Unit:

Type of Waiver: General Fund: Extended Studies:

(See Guidelines on back of form)

Employee Fall Summer Session

Spouse Spring Weekend College

*Dependent Child Other Other

This is to certify that the information submitted on this application is complete and accurate. If the waiver application is for a spouse or dependent child, I hereby attest that the above named student is my spouse or dependent child and, if the latter, that I claim such child as a dependent on my last tax return or that I am legally required to provide for such child’s support even if I did not claim such child as a dependent for income tax purposes. *

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Signature of Employee

CERTIFICATE OF EMPLOYER

This is to certify that the above named employee is employed by the Board of Trustees of Community-Technical Colleges at NORWALK COMMUNITY COLLEGE, and is eligible to receive a waiver of tuition and fees, as requested in this application, pursuant to Board policy and/or pursuant to an applicable collective bargaining agreement.

Human Resources Office Date

For Extended Studies Only:

Dean of Extended Studies Date

Number:

Date/Time Received:

*NOTE: The Board reserves the right to require submission of tax returns to substantiate claimed spousal or dependent child status. False reporting may be cause for disciplinary action.

WAIVER GUIDELINES FOR COURSES UNDER EXTENDED STUDIES

(Request for waiver must be approved by the Dean of Extended Studies)

1.  Waivers are granted on a “space available” basis. “Space available” means that no fee-paying student will be displaced and paying students who register late may displace unit members.

2.  There must be sufficient enrollment to offer the course without the waiver student.

3.  Not all credit extension courses are eligible for fee waiver. Please verify with the Dean of Extended Studies that the course you are interested in is eligible under this program.

4.  The student will assume all additional costs, including texts and materials fees.

5.  Waivers will only be granted beginning 48 hours before the start of classes. If a class begins on a Monday, waivers will be granted beginning on the Friday prior to the start of classes.

6.  If you decide to register for a class to guarantee a seat in the class, you may not withdraw at a later date and request a waiver for the same class.

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