Account Number/Class Code: 131-6-331006-9968
UW-Stout
Request for Authorization to Waive Tuition for Supervising Teachers
Name__________________________________SS#_____________________
Home
Address________________________________________________________
School
Address________________________________________________________
NOTE:
In the event the course is not successfully completed within the one year
time limit, the fees will be charged to the student.
Signature______________________________________________________
Approval by School of Education
Grade Issued:____________
Approved:___________
Term:_____________
Not Approved:_______________
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Approval by School of Education
______________________________________________
Associate Dean of Professional Education (Signature)
Final approval for waiver of tuition cost by the University is contingent upon
presentation of evidence of successful completion of the course as evidenced by
a copy of the grade roster provided by the School of Education.
Reimbursement of this fee by the University indicates commitment to serve as a
supervising teacher for the University of Wisconsin-Stout (or UW System).