Kutztown UniversityAPPLICATION FOR TUITION FEE WAIVER 
Dependent/Spouse of Covered Employees Attending Kutztown University

SECTION I - TO BE COMPLETED BY EMPLOYEE. QUESTIONS SHOULD BE DIRECTED TO HUMAN RESOURCES.

RELATIONSHIP TO THE KU EMPLOYEE * 
 
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SEMESTER (PLEASE CHECK ONE) * 
 
EMPLOYING UNIVERSITY: KUTZTOWN UNIVERSITY
EMPLOYEE STATUS (PLEASE CHECK ONE) *
 
UNIT (PLEASE CHECK ONE) *

INDEPENDENT STUDY / INDIVIDUALIZED INSTRUCTION COURSES ARE NOT COVERED BY TUITION WAIVER.

*Employees of AFSCME, OPEIU and SPFPA units must have completed their probationary period prior to beginning of attending semester to be eligible for tuition waivers. NO spousal tuition waiver for OPEIU.

Note: This application should be submitted no later than eight weeks prior to the deadline for payment each semester. The tuition waiver is applicable until the student obtains his/her first undergraduate degree.

Does this student have an undergraduate degree from any college/university? * 
Is dependent spouse on your medical benefits plan? * 
Is DEPENDENT CHILD 25 years of age on the first day of semester? * 
Is this the student first semester at Kutztown University? * 
Please select your preference to submit the document. * 

Note: Student is not eligible for tuition waiver at this time based on your response to the eligibility questions. Please contact Human Resources at 610-683-1353 for assistance.

Note: Your tuition waiver will be held until Human Resources received the proof of age document. Please bring a copy to the Kemp Building as soon as possible.

I certify that the above information is accurate to the best of my knowledge and belief.  I further certify that the student named above meets all the normal academic requirements for admission to Kutztown University, and is pursuing his/her first undergraduate degree.  I understand that willful falsification of any of this information could subject me to the full cost of the tuition being waived, and such other penalties as applicable laws and regulations may permit.
Employee's Signature (you may sign with your mouse or sign with fingers on a touch screen device) *
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SECTION II - TO BE COMPLETED BY HUMAN RESOURCES

The employee’s eligibility for the tuition waiver has been reviewed, and I hereby certify that the information submitted is true and accurate to the best of my knowledge.  Entered Date: ____________   Verified by: Initials_______ Date____________ 
 
 
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Human Resources Approval                                                                  Date
If you do not receive a confirmation email, please check spam.  Please contact Human Resources should you have any questions regarding tuition waivers.