LONG ISLAND UNIVERSITY
TUITION REMISSION APPLICATION
For Employees, Spouses, or Dependent Children

Employees, their spouses and dependents children are eligible for tuition remission benefits. Tuition remission for a son or daughter of the employee may only be granted if the child is a dependent, with dependency status defined by and acceptable to the Internal Revenue Service during the calendar year in which remission is sought. Tuition remission benefits will be extended to dependent children for 8 full-time semesters of the equivalent part-time study. Application for tuition remission must be made initially at least one month before the registration period. The approved application, assuming no change in status, will remain in force for the balance of the academic year. Application must be renewed one month prior to the student's first registration in each succeeding academic year.

THE EMPLOYEE MUST COMPLETE "PART A' OF THIS FORM AND RETURN TWO COPIES TOGETHER WITH COMPLETED PELL GRANT AND TAP APPLICATIONS, OR A SIGNED STATEMENT INDICATING INELIGIBILITY FOR SAME, TO "PAYROLL DEPARTMENT, LONG ISLAND UNIVERSITY ADMINISTRATION CENTER, BROOKVILLE, NY 11548." THIS APPLICATION WILL NOT BE PROCESSED UNLESS IT IS ACCOMPANIED BY A COMPLETED PELL GRANT APPLICATION, AND, IF STUDENT IS FULL-TIME, A COMPLETED TAP APPLICATION.

PART A - TO BE COMPLETED BY EMPLOYEE (Please PRINT all information)

TUITION REMISSION REQUESTED FOR:

I have read and understand the University's statement of policy concerning tuition remission benefits.

Normally an employee may not register or be granted remission for courses during working hours. Remission is also not extended to non-credit courses or individual instruction.