1. Tuition Remission Instructions

2. 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 the form to
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

3. 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

4. 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