Tuition Exchange Application
Due in Human Resources by November 30
Student Name:
Address:
City, State, Zip:
Telephone #:
Date of Birth:
Student Email:
Social Security # (just last 4 digits)
Applying as: (please circle)
Freshman
Sophomore
Junior
Senior
List participating schools you are applying for:
1.
2.
3.
4.
5.
6.
7.
Employee Name:
Employee Email:
My son/daughter will also apply for Tuition Remission at Pacific.
 Yes
 No
The applicant shown above is my legal dependent according to the IRS definition* of
“qualifying child”.
(* available on the www.irs.gov website)
Employee Signature
Date