Employee Tuition Benefit Application

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Employee Tuition Benefit Application - ACU Abilene

This is the application for the Employee Tuition Benefit. Before completing this form, please read the policy on this benefit. The policy can be found at :

https://acu.edu/human-resources/benefits/

This form is due before or on the 12th day of class every January. Failure to submit this form will result in the loss of this benefit for the year it is not received.

Please note that employee tuition benefits do not apply to intercollegiate hours taken at HSU or McMurry, or any discounted program (i.e. Summer Academy).

Other important IRS information regarding who qualifies as an IRS dependent can be found here:

http://www.irs.gov/publications/p501/ar02.html#en_US_2012_publink1000220868

If you are unsure of the dependency status of the beneficiary of the benefit, please contact a tax professional.

I have read and understand the Employee Tuition Benefit Policy and the related deadlines.

Required

Student's First Name *

Student's Last Name *

Student's Banner ID *

Employee's First Name *

Employee's Last Name *

Employee's Banner ID *

Which campus do you work for? *

Abilene

Dallas

Date of Hire *

Department *

Phone Number *

Employee Type *

Employment Status *

Student's Relationship to Employee *

Student's Program *

Student's Birthday *

Student's age at the end of the tax year that the benefit is to be received *

Student's Marital Status *

Do you expect any change in the student's marital status during the tax year? *

I understand that if the person receiving this benefit is no longer a tax dependent as of the end of the tax year, the benefit received for the entire year becomes taxable to me. I agree to notify Human Resources as soon as I am aware of the change. If, in the case I do not notify Human Resources of the dependency status change, I understand that tax withholdings paid for by the University on my behalf will be charged to the beneficiary's account. If the account is not paid in full, the student may have holds put on, and may not be able to register for future semesters. In addition, the account is subject to ACU's regular collections process. I also understand that discovery of a change in dependency status may result in the need for a corrected 1098-T or W-2.

Required

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