UNIVERSITY OF PIKEVILLE (Undergraduate Tuition Waiver Agreement)
SECTION 1:
Date of Request:
Semester for which waiver is requested:
Fall☐ Spring☐
Year:
SECTION 2:
EMPLOYEE INFORMATION:
Name: (Last, First, M.I.)
Address:
State:
City:
Zip Code:
Department Name:
Title:
SS#: (last 4) xxx-xxEmail:
Contact Number:
SECTION 3:
Complete the following course information (Employee Only)
Course No.
Course Description
Credit. Hrs.
Day(s)
SECTION 3:
Spouse/Dependent Information (To be completed if Spouse/Dependent enrollment)
Name: (Last, First, M.I.)
SS#: (last 4) xxx-xx-
Relationship to Employee:
Date of Birth (if dependent child)
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Time
UNIVERSITY OF PIKEVILLE (Undergraduate Tuition Waiver Agreement)
SECTION 4: Guidelines
Tuition Waivers for Faculty/Staff, Spouses and Dependent Children
Eligibility: Employees must be employed by the University for one year prior to the beginning of classes in order to
receive a tuition waiver for oneself or dependent. Regular full-time employees are eligible for this tuition benefit. The
Employee Tuition Waiver Agreement and FASFA forms must be completed in Student Financial Services. You, your spouse or
dependent children are eligible if they have not yet earned an undergraduate degree. A dependent child is eligible if you have
claimed the child on your tax return for the previous calendar year, and the child continues to meet the IRS definition of a
dependent. If you have any questions about employee eligibility, contact the Human Resources Office at 606-218-5346. The HR
office is located in the Community Technology Center, Second Floor 119 College Street, Suite 210, Pikeville, KY 41501.
Applicability:
Employees who do not have a bachelor’s degree are eligible for undergraduate tuition waiver for academic credit. A spouse or
dependent child may use the tuition waiver for academic credit courses only. The scholarship waiver applies only to tuition and
not to special course fees or other fees required for a course.
A dependent child is defined as one who is an unmarried natural child, adopted child, stepchild or legal ward and is less than 24
years of age as of the first day of the semester for which the class is offered and who is claimed by the employee for income tax
purposes. Spouses and/or dependent children must meet University admission requirements and any specific program
requirements.
Your spouse and children may be eligible for tuition waivers for up to a maximum of 10 regular semesters each. Waivers are
granted on a first-come, first-serve basis within the University’s budgetary guidelines.
Spouses and dependent children may apply for tuition waivers for up to 18 hours for both the fall and spring semesters.
Employees, spouses and children must apply for financial aid. The deadline for applications is January 31st each year and
financial aid will be applied to cover the cost of tuition before tuition waivers are applied. Tuition waivers cannot be applied to
room and board expenses.
Dependents that are in high school and attending University of Pikeville in a dual-credit program will not be eligible to receive
the employee tuition waiver.
Scheduling:
Employees may take one course during normal working hours in the fall and spring. The employee must make arrangements with
his/her supervisor to make up the time or request time without pay. The employee is required to provide a request to their
immediate supervisor at least four weeks before the course is to start. The employee must apply for financial aid and be formally
registered. Permission to take a course during normal working hours is not automatically granted — it will depend on the needs
of your division or department, as determined by your supervisor. If approval is granted by your immediate supervisor to take a
class during the day, you will be required to make up the time missed from taking such class. Make-up time must be scheduled
with your immediate supervisor’s approval at the time the request is approved. Time cannot be made up during the employee’s
lunch hour. A course taken during normal working hours cannot last longer than the equivalent of three classroom hours.
Additional hours are allowed if they are taken after your regular work hours and if they are part of the regular class time as shown
in the current schedule of classes for the semester. Employees will not be able to utilize the tuition waiver policy for independent
study, work experience credit or credit by examination.
You may take up to two additional courses, tuition-free, in the evening. However, the combined number of credit hours for the
day and evening courses cannot exceed nine hours. Any financial aid you receive will be applied to cover the cost of tuition — up
to the amount that would be waived — before tuition is waived.
Procedures:
1.
2.
Employees should complete a Faculty/Staff Tuition Waiver Agreement immediately after enrolling into a course(s).
The individual is responsible for obtaining all required signatures (see Section 6). Each department should keep a copy of
this form on file for each employee. Completed and signed forms should be submitted to Student Financial Services. You
must complete a tuition waiver request each semester for all classes.
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UNIVERSITY OF PIKEVILLE (Undergraduate Tuition Waiver Agreement)
3.
4.
Employee/spouse/dependent must complete a FASFA annually by January 31st of the year to receive this benefit each
academic year. Employee must present a Federal tax return to verify exemptions on qualifying spouse/dependents to
Student Financial Services.
Employees must notify the Director of Student Financial Services each semester of the number of hours registered to take
so that the award may be processed accordingly.
Exclusions:
• Employees, spouse and/or dependents are not eligible for any summer and/or independent courses, including on-line courses
and individual instruction.
• Employees who have already achieved a bachelor degree will not be eligible to take undergraduate classes under this policy
unless the course will enhance the employee’s skill and ability level in their current position. The employee’s immediate
supervisor will be responsible for approving any class above the employee’s bachelor’s degree that satisfies the employee skill &
ability requirements.
• Tuition waivers are not given when an employee, spouse or dependent child enrolls in a course that is under-enrolled and where
the instructor is paid on a pro-rated basis. If this happens, the employee, spouse or dependent child is expected to withdraw from
the course or pay the pro-rated amount.
All other expenses associated with enrollment are the sole responsibility of the student. This includes fees, lab
expenses and books.
SECTION 5:
(Financial Aid Office use only)
The above employee is eligible to receive undergraduate tuition expenses for the __________semester up to $________.
SECTION 6: (Required Signatures)

Undergraduate Tuition Waiver Agreements must be signed by the employee’s department head.
**** By signing this document, the employee acknowledges that they have read and agree to abide by the policies and
procedures as stated above.
_____________________________ _________
_________________________ ________
Employee/Student Signature
Department Head
Date
________________________________ ___________
Human Resources
Date
Date
____________________________ _________
Director Student Financial Services Date
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