APPLICATION FOR STAFF COUNCIL TUITION ASSISTANCE
FALL SPRING SUMMER1 SUMMER2 SEMESTER, 2006 2007 2008 TUITION OR PORTFOLIO REIMBURSEMENT
NAME IN-STATE RESIDENT Yes No
HOME ADDRESS
SOCIAL SECURITY NUMBER E-MAIL
CAMPUS DEPARTMENT P.O. BOX PHONE EXT.
THIS INFORMATION FROM EBO OR OFFICE MANAGER
FIRST THREE NUMBERS OF JOB TITLE -- HOURS WORKED WEEKLY
EDUCATIONAL INFORMATION
DO YOU CURRENTLY ATTEND A COLLEGE OR UNIVERSITY? Yes No IF YES, NAME OF INSTITUTION IF NO, HAVE YOU APPLIED TO A COLLEGE OR UNIVERSITY? Yes No IF YES, NAME OF INSTITUTION IF NO, WHAT INSTITUTION DO YOU PLAN TO ATTEND? WHAT PROGRAM OR MAJOR? MY CURRENT GRADE POINT AVERAGE IS (REFER TO # 8 UNDER ELIGIBILITY REQUIREMENTS) DO YOU HAVE A COLLEGE DEGREE? No Yes IF YES, SELECT ALL THAT APPLY: ASSOCIATE BACHELOR MASTERS PH.D. NOTE: DEGREE INFORMATION WILL BE VERIFIED. ARE YOU SEEKING ASSISTANCE FOR A (3) OR (4) CREDIT CLASS? 3 4
CERTIFICATION
I certify that the above statements are true and authorize Staff Council's Tuition Assistance Committee to make inquiries it deems necessary with this application. I understand this assistance is for obtaining the first UNDERGRADUATE DEGREE and confirms that I am not seeking assistance for credits toward a graduate degree and that I am not a graduate student.
Endorsement of this request by the Supervisor, Dean or Director is required if the course is to be taken during the employee's regular working hours. Employees must adhere to the guidelines established by the WVU policy on Educational Release Time. Please indicate N/A on the signature line if this section is not applicable to your class time.
Click here to return to eligibility requirements
After completing the above form -- print, sign and send to the Staff Council Office, P.O. Box 6850 prior to the deadline.
Last update: May 22, 2001
