FeeWaiver_CareerDev 2009.pdf - California State University ...



CALIFORNIA STATE UNIVERSITY, EAST BAY

TUITION FEE WAIVER APPLICATION (SELF)

INSTRUCTIONS: Please review eligibility criteria on the following website before completing this form: csueastbay.edu/HR

This application is to be completed by eligible employees requesting admission to the Tuition Fee Waiver Program. Eligible employees must obtain authorization from their immediate supervisor and the Office of Human Resources or if faculty, from the Vice President, Academic Affairs.

TERM APPLYING FOR: □ Quarter □ Semester Campus to Attend: Due Date:

□ F 20___ □ W 20___ □ S 20___ □ SUM 20___ □ NEW or □ CONTINUING

□ Career Development* □ Work Related

(*Note: An “Individual Career Development Plan” must be submitted or already on file in HR.)

Name of Employee: Classification:

Department:

Department ID: (Required)

PS ID: Bargaining Unit/MPP:

Work No.:

Class Standing: Freshman Sophmore Junior Senior Graduate Doctorate

Declared Major:

Please list all course(s) for which you are applying for the Fee Waiver Program in the table below:

|DEPARTMENT |COURSE-SECTION # |TITLE |UNITS |DAYS |TIME |

| | - | | | | |

| | - | | | | |

| |- | | | | |

| | - | | | | |

Employee requests waiver of fees for one course during regularly scheduled working hours. *

Employee requests waiver of fees for____________ course(s) on own time.

Employee requests waiver of fees for one course during regularly scheduled working hours and one course on own time.

( Online and off campus courses do not qualify for release time. If more than one course is being taken during

regularly scheduled working hours, employee's schedule will be adjusted as follows:

|REQUIRED: Describe how the content of the course(s) listed above relates to either your employment (if “Work Related”) or your degree objective (if “Career Development”).|

|Attach additional page(s) if needed. |

□ Proof of payment received and verified _________ (HR initials)

I hereby authorize the Office of Human Resources to review my grades for evaluation of progress in this program. I understand that if I change courses, this will require me to submit a new Tuition Fee Waiver application.

Employee’s Signature

Date

Approval – Appropriate MPP Administrator’s Signature Date

*Approval – Vice President, Academic Affairs

(VP signature for Faculty/R03 Only)

Date

Approved for units Denied for reason of:

Approval – Human Resources Office Date

Rev June 2017 S:\Training & Development\Fee Waiver\FeeWaiverEmployee Self 6-2017.doc

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