Tuition Assistance Request Form

EMPLOYEE/DEPENDENT TUITION ASSISTANCE REQUEST

West Texas A&M University offers a 50% waiver on all assessed tuition and fees for eligible employees and their dependent family members (See the applicable tuition and fees at this link). If you are an eligible employee, you MUST complete this tuition assistance application at least two weeks before the start of each enrollment term (fall, spring or summer), but no sooner than three months before the start of each enrollment term. The application only covers one semester and MUST be completed before each semester you wish to have the assistance. An employee's supervisor must first approve the waiver submission and then submit it to Human Resources for validation and approval before transitioning to the University registrar's office for residency coding and verification of good academic standing. The form will then go to the University business office for billing adjustment.

Please review the program considerations and limitations at the institutional level and eligibility Considerations as well as the tax considerations regarding this assistance at this link. Please contact your financial advisor or tax preparer regarding tax consequences prior to submission. This application must be completed and approved prior to the 12th day of class each semester.

EMPLOYEE INFORMATION

First Name:*

Last Name:*

Comments

Employee Email*

UIN:*

Employee Buff ID#*

Department:*

Supervisor:*

Supervisor Email*

Employee Title:*

Employee Type:*

Select or enter value

Application Supports:*

Select or enter value

DEPENDENT INFORMATION

Dependent's Full Name (if applicable)

Buff ID of Dependent (if applicable):

Dependent Relationship (if applicable):

Select

DEGREE INFORMATION

Degree Program Level:*

Select or enter value

Degree Program:*

For a complete list of University degree programs, use this link.

Semester:*

Select

Semester Year:*

How many hours do you plan on taking this semester?*

CERTIFICATIONS - PLEASE READ VERY CAREFULLY

As the requesting employee, I hereby certify that I am in a benefit eligible position at 50% or more FTE at WT prior to the beginning of the semester I am requesting assistance for. (If I am the person this application supports for the Tuition and Fees reduction).*

I hereby certify (if this application supports a dependent) the dependent I am requesting this fee reduction is reported on my tax return in the year of the benefit and I as the employee I qualify for the 50% Tuition and Fee Program.*

I (we if applicable) further certify we have read the Guidelines for the Employee and Dependent 50 % Tuition and Fee Program and understand the Considerations and Limitations at the Institution Level and the Eligibility Considerations.*

Under penalty of perjury, I (we if applicable) affirm the above information is true and accurate.*

Proof of Dependency

REQUIRED IF you are applying to have dependent tuition assistance. Please provide one of the following:

For your Spouse:

1) Registered Marriage Certificate

2) Note they are listed on your TAMUS Benefits with WTAMU

3) Your most recent tax return. You would only need to add the first page with dependents listed and can redact the social security number to prove your dependent is covered under you on your tax return.

For Dependent Children:

1) A copy of the child's birth certificate or adoption certificate naming the employee or employee's spouse as the child's parent

2) A copy of appropriate custody or allocation of parental responsibility document naming the employee or employee's spouse as the responsible party to provide support or insurance for the child

Drag and drop files here or

Submitted forms will be reviewed for approval by your supervisor then forwarded to Human Resources.

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