Procedure No. 107.1 - Supplement 1
Area: Academics

Adopted: 04/23/96
Revisions Approved: 8/3/10

Adjunct Tuition Waiver Procedure – Supplement

Department Chair Approval Form for Adjuncts

Adjunct Instructor Name:___________________________________

Date:_______________

Employee ID #:_________________________

Semester Course to be Taken: __________

Courses being taught this semester (or this summer):

___________________________________________________________

___________________________________________________________

The above named adjunct instructor is eligible to take a credit course, tuition free, this semester. He/she must enroll on the last day of registration and must pay any lab or materials fees connected with the course. By signature on this form, the adjunct agrees that if a grade of “C” or better is not earned in the course, the adjunct shall be responsible to reimburse the college for the full expense of the waived tuition.

Adjunct Signature: __________________________________________________________

Department Chairperson Signature: _____________________________________________________

Human Resources Signature: _____________________________________________

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