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 Last 4 digits are acceptable JHED ID Employee Name Employee Full Name Employment Date Start date of your current employment Dept. Code. Department code Refer to your E-210 form

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-Executive- Continuing Programs- 100% Signature Need to print out the document to sign

Department Budget Number This budget number is required and will be charged only if (1) the participant cancels within one week of the program start date, or (2) fails to attend, or (3) is otherwise found to be ineligible for the tuition benefit. In any of these circumstances, the department is liable for the course fee. Supervisor or Department Head Signature Need to print and sign HR Approval for Retirees Only applies if the application is for a retiree