WSU SPOUSE TUITION ASSISTANCE APPLICATION

Refer to Tuition Assistance Program for Spouses and Dependent Children, WSU Policy 3.43.

Applicants must complete a new application each semester they wish to be considered for this program.

Full-time Employee (1.0 FTE) Information: / Revised: 05/11/2016
Name:
Spouse Information:
myWSU#: / Work phone / Name:
Department: / Home Address:
Campus Box #:
myWSU#:

Check only 1 semester per application:

Fall Semester: / (Applications accepted April 1st through July 1st only)
Spring Semester: / (Applications accepted October 1st through December 1st only)

This application must be completed in its entirety to be accepted.

To Be Completed by Spouse Applying for Tuition Assistance
Is applicant defined as a spouse as recognized under Kansas state law for purposes of marriage,
including common law, or a domestic partner of the University employee? / Yes / No
Have you been admitted to a degree-seeking graduate, undergraduate or professional academic program
at Wichita State University? / Yes / No
Is your primary program: / Undergraduate / Graduate
Are you in good academic standing? (Making satisfactory academic progress.) / Yes / No
I have read and agree to the provisions of this program (WSU Policy & Procedures 3.43). By signing this application, I authorize the administrators of this program to check my grade point average.
Applicant’s signature: / Date:
To be Completed by the Employee
I have read and agree to the provisions of this program (WSU Policy & Procedures 3.43). The information on this application is complete and accurate to the best of my knowledge, and I certify that my spouse meets the requirements of this program.
Employee’s signature: / Date:
ICAA Employees Only (Non state employee awards will be billed to ICAA):
Is employee a state employee? / Or employee of Affiliated Corporation?
Signature – Ruth Matz, ICAA Director of Administration & Personnel:

Return completed application to Sarah Hunter at Campus Box 15 or Fax to 978-3201.

HR USE ONLY: / Minimum $$ Approved:
Assistance Approved / Yes / No / Maximum $$ Approved:
# Semesters Previously Approved: