Carlow University Employee Education Benefit Request Form by lxb51761


									                                              Carlow University
                                   Employee Education Benefit Request Form
                                             Dependent / Spouse

This form is for employees of Carlow University who are requesting an education benefit for their dependent
or spouse. Refer to your Employee Handbook for eligibility criteria. This form must be submitted to the
Human Resource Office prior to the semester for which you are requesting the Education Benefit. A new
form much be submitted each semester. The benefit will not be applied retroactively.

                                          Part One. Employee Information

Employee Name                                                                                         Carlow ID

Department                                                                                            Phone

                                    Part Two. Dependent/Spouse Information

Student Name                                                                                          Carlow ID

Relation to Employee                  Dependent*                            Date of Birth             /         /

*A dependent is defined according to Internal Revenue Service guidelines. Attach copy of most recent federal income tax return
to this form.

The student (dependent or spouse) must apply for federal and state grants by completing a Free Application
for Federal Student Aid. File on-line at Paper applications are also available. Call the
Financial Aid Office at X6058 to request one.

                                        Part Three. Enrollment Information

This benefit is applicable only to coursework leading to an undergraduate degree at Carlow University. It is
limited to 120 credits (125 for Nursing) or eight full-time semesters, whichever comes first.

Semester                Fall 20                 Spring 20                        Summer 20_____

Number of credits                     The student must notify the Financial Aid Office if credits are added or dropped.

                                                 Part Four. Signatures

Employee Signature                                                                                    Date

Supervisor’s Signature                                                                                Date

Vice-President’s Signature                                                                            Date

            Forward completed form to the Human Resource Office in Frances Warde Hall.

HR Recd.                                              FAO Recd.                                       Benefit
Eligible ( )Yes ( )No                                 Tuition                                         Code
HR Initials                                           Fees                                            Date
                                                      Total                                           FAO

To top