Employee/Spouse Tuition Waiver Application
Instructions & Guidelines
This form should be completed during the student application process (before course registration), and returned to the Human Resources Department (MH 218). Questions may be directed to or 651-641-8846.· Undergraduate classes will have a value of 50 points per credit
· Graduate classes will have a value of 70 points per credit
· Independent Study, Private Music Lessons, and any associated activity fees are not covered by the Tuition Waiver Benefit
· Supervisor approval and accommodations for lost work time must be made for courses that meet during the employee’s work schedule
· The tuition waiver does not extend to spouses taking graduate level courses
For the full tuition waiver policy, visit http://concordia.csp.edu/HumanResources/Policy/index.html.
General Information
Employee Name: / CSP ID:CSP Phone: / CSP E-mail:
Are the courses you are applying for part of a graduate or undergraduate cohort program? Yes No
Course Information
Course for / Class Type / AcademicTerm / Subject & Course Number
(ex. ENG-101) / Course Title / Course Credit Value / Point Value
Employee
Spouse / Undergraduate
Graduate
Employee
Spouse / Undergraduate
Graduate
Employee
Spouse / Undergraduate
Graduate
Employee
Spouse / Undergraduate
Graduate
Employee
Spouse / Undergraduate
Graduate
Total Tuition Waiver Points Used:
Signatures & Approvals
/Tax/Waiver Point Evaluation
I understand that this waiver is an employee benefit and may be considered taxable income to me (as defined by current IRS regulations). Any additional taxable income will be added to my annual gross income. Payroll Taxes will be withheld against this amount. / HR Office Use OnlyTax Evaluation / Point Evaluation
Tuition $ YTD: / Current Available:
Tuition $ Term: / Anticipated:
IRS $ Threshold: / Used:
Employee Signature Date / Taxable Amount: / Remaining:
Approved - Supervisor (employee waiver only) Date / Approved - Director of Human Resources Date
V. 09/01/2005