Tuition Waiver Form

EMPLOYEE REQUEST FOR TUITION WAIVER
Full-time employees of Iowa Lakes may enroll for credit or non-credit courses. Regular part-time employees (at least 1040 hours per year) may enroll for credit courses at the College at no cost, except for eCollege and Ed to Go courses not originating from Iowa Lakes, which will be reimbursed at 50%, according to the following guidelines:

1. Eligibility: All full-time and regular part-time (at least 1040 hours per year) employees of Iowa Lakes.

2. Full-time employees may take up to 6 credit hours or 60 contact hours per semester or summer term. Regular part-time employees may take up to 3 credit hours per semester or summer term.

3. Only tuition, general fees, technology fees, and activity fees are paid by Iowa Lakes. Any books, course or program fees, or other charges are the employee's responsibility, or the supervisor may approve payment for work-related training.

4. If credit courses are not satisfactorily completed with a passing grade, the employee will be responsible for reimbursing the College for the tuition expenses.

5. Continuing Education classes fall under the guidelines for full-time employees only. However, only basic tuition costs will be paid by Iowa Lakes. Any books, materials, or extraordinary costs included in tuition are the employee's responsibility.*

6. Classes taken by employees during normal work hours are only allowed at the supervisor's discretion and are not included as paid time unless the class is taken at the supervisor's request or direction.

7. Employees wishing to register for classes must complete the Employee Request for Tuition Waiver form and have it approved prior to the beginning of the class.

8. When registering for the class(es), a complete and signed copy of this form must be attached to the registration, and the balance of charges due must be paid.

**Please call the Continuing Education department for a breakdown of fees and materials if necessary.
EMPLOYEE DETAILS
Employee Name

First NameLast Name
Datatel Number
Employee Work Phone Number

Area CodePhone Number
Job Title
Department
Employee Supervisor
Employee Email
example@example.com
Who is this waiver for?
As provided in the Spouse and Dependent Children Tuition Credit Administrative Procedures of Iowa Lakes, I request to be enrolled in the course(s) shown on the attached registration form and to be credited accordingly. I understand that I must receive passing grades and that I am subject to other terms of the procedure.
Name

First NameLast Name
Student/Datatel ID
Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Semester (Fall, Spring, Summer)
Term (Year)
COURSE DETAILS

Please use one column for each class you are taking.
What type of course(s) are you taking?

Credit

Rows
Course(s) & Section Number
Credits
Term
Tuition
Time of Day

Continuing Education

Rows
Course Name and Number
Term/Date
Tuition
Time of Day

Other Costs (Complete this section only if other cost are to be paid by the College and charged to an account)

Rows
Miscellaneous
Fees
Books & Materials
Account Number

**Please submit a breakdown of other fees or materials if applicable.
Please submit any relevant documentation (course schedule) pertaining to your course(s).

Upload

Cancelof
Employee Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SUPERVISOR APPROVAL SECTION
Supervisor Name (Approver)

First NameLast Name
Job Title
Supervisor Signature (Approver)
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

EMPLOYEE REQUEST FOR TUITION WAIVER

EMPLOYEE DETAILS

COURSE DETAILS

SUPERVISOR APPROVAL SECTION