Tuition Remission Instructions

Scan and email the form to carey.execed@jhu.edu Academic Term Options Date Fill in the date that you are filling out the form Scan and email the form to carey.execed@jhu.edu Academic Term Options Select Fall (Q1 &Q2) 2015 Telephone# Work phone number SS# Social Security Number JHED ID Employee Name Employee Full Name Employment Date Start date of your current employment Dept Code. Department code

Course Number Course Title Course Cost Course Type Course Offered Do not fill in this box Course Title Full title of the specific seminar you are taking Course Cost Factor in 20% discount Course Type Non-Credit-Professional Development Course Offered Carey-Credit Undergraduate and Graduate-100% Signature Need to print out the document to sign

Department Budget Number This is required in the event that the participant does not attend or fails to cancel with one’s week notice or is other wise ineligible for the tuition benefit and takes the seminar. Then the department is liable for the charge. Supervisor or Department Head Signature Need to print and sign HR Approval for Retirees Only applies if the application is for a retiree