DePaul University
Office of Human Resources
Eligible Child Tuition Waiver Form
For children age 23 to 25, the attached form A must be submitted to the Benefits Office
of Human Resources before the last day to drop classes and receive a 100% refund (see
the Academic Calendar) for the quarter or semester in which the class is taken. This form
is required at the beginning of each term and requires documentation to verify eligibility
per the terms of the policy. Waivers for these dependents are posted after the last day to
drop classes and receive a 100% refund (see the Academic Calendar).
This Form has Two Parts:
A.
B.
Class request (Required)
Additional documentation for undergraduate dependent children required for
the tuition waiver to be tax exempt (Required only for Undergraduate Studies)
Part A: Class Request (required at the beginning of each term)
Complete Form A and return to the Benefits Office of Human Resource. Please note that
as of 1/1/08, eligible children of employees must be under age 26 as of the first day of the
term. The student’s age will be verified from their student record information.
Part B: Additional documentation for undergraduate dependent children required
for the tuition waiver to be tax exempt (only required one time per academic year)
The following documentation must be attached:
1. A prior year tax return showing the student for whom the waiver is being
requested as a tax dependent of the employee or retiree.
-And2. A notarized letter indicating that the child is a Qualifying Child or a Qualifying
Relative tax dependent of the DePaul employee in the year the waiver is being
sought.
For all dependent children age 23 to 25 enrolled in a graduate program the dollar value
of the waiver is immediately taxable to the employee and you will only have to submit the
attached form A to the Benefits Office. Please refer to the tuition waiver policy for more
details regarding taxation of graduate courses.
March 2009
DePaul University
Office of Human Resources
Eligible Child Tuition Waiver Form: Form A
Employee’s Name:
_____________________________________________________
Employee’s ID Number:
_____________________________________________________
Dependent‘s Name:
_____________________________________________________
Dependent’s ID Number:
_____________________________________________________
Academic Year: _____/_____
Student Status (please circle):
Undergraduate
Term (please circle):
Fall
Graduate
Winter
December
Law Fall
Spring
Summer I
Law Spring
Summer II
Law Summer
How many credit hours are you requesting be waived for the term indicated above? ____
Please list the following information for the courses your tuition waiver is to be applied for the above term:
Course Number
Course Name
College/School
Term/Year
____________
________________
________________
________________
____________
________________
________________
________________
____________
________________
________________
________________
____________
________________
________________
________________
Please note: Any individual that is receiving the waiver that does not have a birth date listed in the PeopleSoft system must provide
further documentation to show proof of his/her birth date.
Employee’s Signature:
_________________________________ Date: __________
Dependent’s Signature:
__________________________________Date:__________
Human Resources Approval:
__________________________________Date:__________
March 2009