Baldwin Wallace University Employee Tuition Remission Application

Employee Tuition Remission Application

* Required information

Employee Information:

Full Name:

Department:

Email:

Home Address:

City:

State:

Zipcode:

Work Status:

Payment Type:

Employment Type:

Effective Date:

Date of Hire:

First time applying for benefits?

Are you currently using benefits?

If Yes, for whom?

NOTE: Please list all who are receiving benefit, including yourself.

Have you used beneftis in the past?

If Yes, for whom?

NOTE: Employee must be receiving a paycheck from the College during the term in which taxable benefits are being used.

Student Information

Student's Name:

Student ID#:

Address:

City:

State:

Zipcode:

Relationship to employee:

NOTE: Must be legal dependent to qualify.

Birthdate (if dependent):

Have you been accepted to BW?

If No, you are not eligible; reapply when accepted.

If Yes, what's your start date?

Are you applying for the 2013-2014 academic year?

What are you applying for?

Please indicate your education level as of this term:

Select one or more of the following:

Liberal Arts
Full-time
MBA/IMBA
Certificate

Conservatory
Part-time
MAED
Other

If you checked Other specify here or your application will be rejected.:

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