<< Bursar's Office
Bursar's Office, Kumble Hall
C.W. Post Campus, Long Island University
720 Northern Blvd., Brookville, New York 11548
Fax:
516-299-2721
Tuition Remission Application
Print, fill out and mail/fax to above address/fax number
 

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 or 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
Employee's Name:
   
Campus Employed:
 
Full Name of Student:
   
Relationship to Employee:
 
Social Security No:
 
Employment Date:
 
Birth Date of Child:
 
Student's Social Security No:
 
If applicable, please check whether or not child is claimed as a dependent for income tax purposes:
Credit
 
Debit
 

TUITION REMISSION REQUESTED FOR
Semester
 
Year
 
Grad
 
Undergrad
 
Campus
 
Employee's Signature & Date:
 
 
Supervisor's Signature & Date:
(for Employee remission only)
 
 
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.

PART B - FOR PAYROLL USE ONLY:

TUITION & FEES:

FOR BURSAR OFFICE USE ONLY

 
ADJUNCT
 
 
 
 
 
 
 
 
 
 
 
 
Full  
100%  
80%  
60%  
APPROVED BY: DATE



PENDING: TAP  
PELL  
DEPENDENCY