APPLICA
ATION FOR TU
UITION FEE W
WAIVER
R
AFSCM
ME and SPFPA
A cover ed emp
ployees
s
(Taking Courses Un
nder the Non
n-Instructional Tuition W
Waiver Policy)
SECT
TION I – Ques
stions shoulld be directed to Human Resources. (PLEASE PR
RINT)
EMPLO
OYEE NAME:
EMPL
LOYEE ID:
Seme
ester: (Plea
ase check one)
o
Fa
all 20____
Spring 20_
____
Summer I 20___
__
Summ
mer II 20____
_
AFSCME
SPF
FPA (Police)
Barga
aining Unit: (Please check one)
Other_
___________
____________
_
Note: Employees of AFSCME & SPFPA units must have
e completed th
heir probation
nary period prrior to beginning of
emester to be
e eligible for tu
uition waivers
s.
attending se
INDEPENDENT STUDY / INDIVIDUA
ALIZED INSTRUCTION (IS
S/II) COURSE
ES ARE NOT
T COVERED BY TUITION
WAIVER. I T IS THE EM
MPLOYEE RE
ESPONSIBILITY TO IMME
EDIATELY R
REPORT ANY
Y IS/II COURS
SES ADDED
AFTER TUIITION WAIVE
ER FORM HA
AS BEEN SUB
BMITTED TO
O HUMAN RE
ESOURCES F
FOR THAT S
SEMESTER.
The ffollowing undergraduate course(s)
c
I am
m requesting for permission to take a
at Kutztown U
University is/a
are under the
e
tuition
n waiver prov
visions of my bargaining unit
u contract. I understan d that this re
equest is for tuition only, a
and that I am
m
respo
onsible for alll aspects off the registra
ation process
s. A maxim
mum of 6 c
credits per semester (Fall, Spring &
Summ
mer I or II) ma
ay be taken.
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
COURS
SE NUMBER AND TITLE:
CREDITS
S:
DAYS AND T
TIME OF CLASS:
I unde
erstand that I must make up any misse
ed time from my regular w
work schedule
e and I am providing an a
alternate work
k
sched
dule for makin
ng up time du
ue to attending class(es). I also undersstand that thiss information is required to
o comply with
h
contra
actual requirements.
I plan to make up fo
or work time missed in taking
g classes by the following alte
ernative sched
dule. (Your pla
an for making u
up lost time for
attend
ding class may NOT exceed 8 hours of work
k time each day
y.) Please inclu
ude 10 minutess to go and 10 minutes return
n from class.
Totall time neede
ed to attend
d classes pe
er week:
ALTE
ERNATE SCH
HEDULE
Monday
________
__________
________ (in hours/min
nutes)
Tues
sday
Wednesday
Thurs
sday
Friday
Startin
ng Time:
Lunch
h Time:
Ending Time:
Total Make up Time/Day:
Comm
ments:
Emplo
oyee Signaturre
Date
Note: T
This application should
s
be submittted no later than
n eight weeks prior to the deadlin e for payment ea
ach semester.
By ap proving this waiver,
w
I ha ve reviewed
r
this request
r
and I understand
u
tha
at the resultin g absence mu
ust not cau se a
any additional
cost tto th e universiity. I hav e re viewed
v
t he pl an
a t o ma ke u p an y work m
missed. I unde
erstand th at t h
he o perational ne eds o f m y
functio
on take preced
dence, and tha
at I may refuse this request if it would disrupt the work sc
chedule or resu
ult in additiona
al cost.
ure
Superrvisor Signatu
●Bursarr’s Office
●Human Resources
Date
Name:
Line 1:
Semester:
Line 2:
Line 3:
SECTION II – (To be completed by Human Resources)
Checklist:
1. Full-time employee with completed probationary period
2. On active payroll of university
3. Approval from manager
4. Written plan to make up work missed
5. No additional personnel costs for taking courses(s)
NO INDEPENDENT STUDY/INDIVIDUALIZED INSTRUCTION COURSES
6. Maximum of 128 credits through KU waiver program
7. Certification signature of reviewing staff member
8. Waiver approval signature
A C C O U N T I N G
PS TUITION:
CODES
PS TECH FEE:
Verified by: Initials___________ Date___________ Entered___________
Approval:
Executive Director of Human Resources
●Bursar’s Office
●Human Resources
Date