NOTE:  Tuition Waiver covers TUITION ONLY.   Student is responsible for payment of all other fees.

Prince William Sound Community College                                                              TUITION WAIVER REQUEST

WAIVER TYPE

/

(  ) Employee/ Disabled - Regent's Policy 04.06.010

Semester

Year

Applicant Student ID Number

(  ) Spouse/Domestic Partner

(  ) Dependent

Applicant Name (dependent/spouse/domestic partner)  PLEASE PRINT

(  ) Adjunct Faculty - Collective Bargaining Agreement 14.2

(  ) Spouse/Domestic Partner

(  ) Dependent

Employee Name and his/her Student ID (if applicant is dependent or spouse/domestic partner)

(  ) Senior Citizen - Regent's Polciy 05.10.01(E)(3)

COURSES WAIVED (not applicable to self-support courses or fees)                     Graduate Courses

Taxable *

Department

Course No.

Course Title

Days

Hours ●

No. Credits

Yes          No ♦

(   )          (   )

(   )          (   )

(   )          (   )

(   )          (   )

(   )          (   )

ADJUNCT FACULTY CRITERIA

A tuition waiver of up to three (3) credit hours may be granted to an adjunt faculty member OR his/her spouse/domestic partner OR dependent under

the age of 24 (i.e., 3 credit hours per semester per adjunct faculty member and family) if the following conditions apply:

1.  The adjunct must have a current contract for the semester that corresponds to the tuition waiver.

2.  The contract must be for teaching a course(s) for credit.

3.  The waiver is valid only on a "space available" basis.  It cannot be used to waive the tuition for any class that was full or had a wait-list on the first

day of class OR the date the student paid, whichever date was later.

4.  The waiver is for tuition only.  The individual using the waiver is responsible for the payment of all other associated course and student fees.

* DETERMINATION OF TAXABILITY *

Tuition waived for graduate courses (i.e., 600 level) taken by a university employee, his/her spouse/domestic partner or dependent(s) is taxable to the

employee and will be included in the employee's W-2 as taxable income.  The only exception is for graduate tuition waived for work-related courses

taken by a university employee.  The definition of "work-related" is courses taken to maintain or improve skills required for the present position of

employment.  (NOTE: If the university employee's spouse/domestic partner or dependent(s) has a graduate tuition waiver and the graduate classes

are work-related to the spouse/domestic partner or dependent(s), the waived amount is included in the university employee's W-2 as taxable income.)

EMPLOYEE STATEMENT OF ELIGIBILITY

The below-signed employee certifies that he/she is eligible, under current university policy, for the tuition waiver that is requested and agrees to take

full responsibility for tuition charges should it be determined that he/she is not eligible for this waiver.  If the waiver is requested for the employee,

____ credits were waived during the current academic year (Fall through Summer, maximum of 12).  If the waiver is for a dependent, the employee

certifies that he/she is under 24 years of age.

Signature of Employee:________________________________________  Phone #:_____________________  Date:_____________________

EMPLOYER VERIFICATION OF ELIGIBILITY

The below-signed supervisor certifies that the employee listed above and or/dependent/spouse/domestic partner is eligible for this tuition waiver.

Are the graduate course work-related? ♦

Yes (   ) ♦                 No (   )

Does the applicant have tuition waiver eligibility under layoff satus?

Signature of Dean/Director/Department Head:___________________________________________________ Date:_______________________

●    (    )    Department Head Approval for Course(s) Taken During Work Hours

♦    (    )    Department Head Approval if Graduate Course(s) is/are Work-Related

Signature of Dean/Director/Department Head:___________________________________________________ Date:_______________________

SENIOR CITIZEN CERTIFICATION OF ELIGIBILITY         I certify that I am an Alaskan resident, age 60 or older.

Waiver is valid on a "space available" basis only, when course can accommodate seniors in addition to regularly enrolled students.

Signature of Applicant:____________________________________________________________________ Date:________________________

PLEASE RETAIN A COPY FOR YOUR RECORDS        See Regent's Policy and Regulations referred to above at http://www.alaska.edu/bor.index.html         Revised 2/06