Dependent Tuition Remission

Student/Dependent UofL ID Number (Required)

Term (Required)

Spring 13
Summer 13
Fall 13

Student/Dependent First Name (Required)

Student/Dependent Last Name (Required)

Student/Dependent Date of Birth (Required)

/ /

Dependant Status (Required)

A dependent child (birth, legally adopted, legal ward, or stepchild) reported by me as a dependent for tax purposes. Dependent child is taking courses toward their first undergraduate degree. Hire date AFTER 07-01-78: Dependent child has not attained the age of 26 as of the first day of classes for the semester. Effective Fall 2012, total tuition remission benefits for a dependent child shall be limited to 144 credit hours (including credit hours transferred to UofL, if any).
A dependent child (birth, legally adopted, legal ward, or stepchild) who is NOT reported by me as a dependent for tax purposes, but is nevertheless my dependent because I provide more than 50% of his/her financial support. Dependent child is taking courses toward their first undergraduate degree. Hire Date AFTER 07-01-78: Dependent child has not attained the age of 26 as of the first day of classes for the semester. Effective Fall 2012, total tuition remission benefits for a dependent child shall be limited to 144 credit hours (including credit hours transferred to UofL, if any).
An emancipated child whose parent began continuous permanent full-time employment prior to February 18, 1966 and is pursuing the first undergraduate degree.
The spouse of a faculty member who has had continuous, regular, full-time employment on, or before, July 1, 1978.
Other: Please explain in comments section

Employee ID Number (Required)

Employee First Name (Required)

Employee Last Name (Required)

Employee E-Mail Address (Required)

Comments

Acknowledgement (Required)

Submitting this form acknowledges the following: Claiming benefits under the tuition remission program for anyone who is subsequently determined to be ineligible shall be construed as a misappropriation of University funds and subject the sponsoring employee to discipline, including dismissal, and the forfeiture of any tuition remission benefits previously received.

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