APPLICATION FOR ULM TUITION BENEFIT
LOUISIANA DELTA COMMUNITY COLLEGE EMPLOYEE
This form must be submitted for each semester in which the tuition benefit is requested. Submit a copy with original signatures
at least two weeks before ULM’s final bill payment date of the semester to:
Controller’s Office
University of Louisiana at Monroe
700 University Ave.
Monroe, LA 71209
Bill payment dates are available at ULM’s Student Account Services web site: http://www.ulm.edu/controller/sas/.
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LDCC Employee’s Name (Last, First MI)
LDCC ID Number
ULM Campus Wide ID Number
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Degree being pursued (e.g., BA, BS, MS, or MA.)
Major (e.g., Accounting, English, Elementary Education)
☐ FALL ☐ WINTERSESSION ☐ SPRING ☐ SUMMER I ☐ SUMMER II
Semester to Apply Benefit
Subject and Course Number (e.g., INSU 3307)
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Credit hours
Year
CRN (e.g., 40098)
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1. The following conditions apply to LDCC employees who seek the ULM tuition benefit below. The employee must:
a. be a degree-seeking student at ULM,
b. be employed on a full-time basis at LDCC,
c. submit an application for admission to ULM and pay the appropriate application fee,
d. meet admission requirements for ULM,
e. adhere to ULM policies and procedures, and
f. submit a signed and completed copy of this form for each semester in which the benefit is requested.
2. LDCC employees who meet all requirements listed above may register at ULM for
a. up to six credit hours (cr) per term in undergraduate courses at a rate of $25.00 per credit hour; or
b. up to six credit hours (cr) per term in graduate courses at a rate of $50.00 per credit hour.
3. LDCC employees who enroll in ULM courses under this program must pay the academic excellence fee, operational fee,
energy surcharge fee, and technology fee, which shall be pro-rated for part-time enrollees.
4. The tuition benefit shall apply only to courses and programs not available at LDCC and for which regular tuition is charged.
5. Courses must be taken for credit; fees will not be waived for audit classes.
6. The tuition benefit may not be used in combination with any other discounted program.
7. LDCC employee account balances must be paid in full each semester.
I certify that I meet all of the criteria and agree to the terms specified above.
LDCC Employee Signature
Date
I certify that the above individual is/will be a full-time employee of Louisiana Delta Community College during the
semester for which the tuition benefit is requested.
Vice Chancellor’s Name
Signature
Date