EESP - Florida Atlantic University

Spring 2018 1-11-18 Summer 2018 1 & 2 5-17-18 Summer 2018 3 6-28-18 Fall 2018 8-23-18

FLORIDA ATLANTIC UNIVERSITY Employee Educational Scholarship Program Forms will not be accepted past 12 NOON on the due date.

YOU MUST COMPLETE SIX MONTHS OF ELIGIBLE FAU EMPLOYMENT TO APPLY. EMPLOYEE INFORMATION

(please type or print all information)

Employee Name

Z#:

Job Title

Check the box that applies

SP  Department

Campus

COURSE INFORMATION COURSE PREFIX

Bldg.

Room

Phone Ext.

Hire Date

AMP

E-mail Address

Faculty

@fau.edu

(Please list courses below for which you desire approval, include alternates)

COURSE TITLE

COURSE CALL #

CREDIT HRS

CLASS DAYS & TIME

Course Level

TERM: Year

Fall

Spring

Summer**

1

2

3

 Undergrad

Graduate

Doctoral

Other 

**SELECT ALL APPLICABLE SUMMER TERMS EMPLOYEE CERTIFICATION (Please see page 2 for important tax information). By signing below, I certify that I have read the page 2 and I understand that: - Participation in the program is to be conducted on my own time. - My supervisor is not obligated to grant time off or leave so I can participate in the program. - Employees eligible for this benefit MUST APPLY FOR ADMISSION AND REGISTER FOR CLASSES. The EESP application DOES NOT substitute for registration for classes. - It will be my responsibility to pay the cost of tuition & applicable fees, if I audit, drop after the drop/add deadline, or receive a grade below a C for undergraduate and below a B for graduate courses. - The value of graduate level tuitiion-free courses may be taxable under the Internal Revenue Code Section 127. (Details on page 2) - I must be in good standing to be eligible for participation in the program. - If repayment is not made for the unsuccessful coursework, the University reserves the right to withhold the amount due from the employee's paycheck. This authorizes Florida Atlantic University's Payroll department to deduct from his/her paycheck monies owed to the Florida Atlantic University for the repayment to the EESP program .

Employee Signature

Date

EMPLOYER AUTHORIZATION - PLEASE CHECK ALL THAT APPLY By signing below, I certify that the courses indicated above:

1. 2. 3. 4.

Maintain or improve the employee's job related skills. Meet the express requirements of the employer or are imposed by the employer as a condition of employment. Were taken to qualify the employee for a career change or to meet the minimum educational requirements of the current job. This employee is in good standing after 6 months of employment or as rated by the most recent employee appraisal form

Employee's Supervisor Signature

Please print name

Date

Dean/Director Signature

Please print name

Date

HUMAN RESOURCES USE ONLY Approval

Disapproval

HR Signature Date

Reason for disapproval:

CASHIER'S OFFICE USE ONLY

Grade at end of Semester

Reason for disapproval

Course 1 Course 2

Cashier's Signature

Date

FLORID A ATLAN TIC UN IVERSITY Procedure related to THE EMPLOYEE ED UCATION AL SCHOLARSHIP PROGRAM (EESP) After com p letin g th is for m p lease r etu r n th e ap p r ov ed , com p leted or igin al to t he H R Dep t, IS4, #232. For qu estion s r egar d in g th is for m , p lease call 561-297-3073. ELIGIBLE EMPLOYEES Fu ll-tim e em p loyees in an establish ed p osition at Flor id a Atlan tic Un iv er sity w h o m eet cer tain ad m ission s an d acad em ic r equ ir em en ts m ay be allow ed to en r oll for u p to six (6) cr ed it h ou r s of in str u ction p er ter m . Em p loyees m u st h av e com p leted six m on th s of con tin u ou s ser v ice w ith FAU an d be in good stan d in g. Ad d ition ally you m u st be an activ e em p loyee for th e en tir e sem ester , or you w ill be r esp on sible for p aym en t. An y u n u sed leav e w ill be ap p lied to balan ce d u e if n ot p aid in fu ll. Em p loyees assig n ed to Tem p or ar y / Visitin g ap p oin tm en ts ar e n ot eligible. APPLICATION PROCESS An em p loyee m u st be ad m itted (d egr ee seekin g or n on -d egr ee seekin g) p r ior to ap p lyin g for th e EESP. In for m ation on ad m ission s r equ ir em en ts an d p r oced u r es m ay be obtain ed fr om th e Ad m ission s Office, Stu d en t Su p p or t Ser v ices Bld g, #113, or call 561-297-3040. (A) Pr ior to r egistr ation , th e eligible em p loyee sh all o btain th e r equ ir ed EESP form fr om Dep ar tm en t. Th is for m is to be com p leted , n ecessar y ap p r ov als ar e to be obtain ed , an d th e for m is to be r etu r n ed to th e H u m an Resou r ce's Ben efits Office for v er ification an d fin al ap p r ov al d u r in g th e w eek of registr ation b u t p r ior to th e last d ay of Dr op Ad d (see sp ecific d ates on p r ev iou s p age). (B) All ap p r ov ed for m s w ill be sen t to th e Un iv er sity Cash ier 's Office by H u m an Resou r ces. Th e Cash ier 's Office w ill d efer 'in state on ly ' tu ition ch ar ges for u p to six sem ester h ou r s u n til th e en d of th e sem ester . Em p loyees w h o r eceiv e a gr ad e of C or better for u n d er gr ad u ate cou r ses an d a B or better for gr ad u ate cou r ses, w ill h av e th e tu ition fee w aiv ed . Th is tu ition w aiv er in clu d es Gr ad u ate cou r ses th at ar e on a Pass/ Fail p r ov ision . An y oth er gr ad e at th e en d of th e sem ester w ill n ot be ap p r ov ed , an d th e em p loyee w ill b e r esp on sible for p aym en t. Wh en d ifferen t cou r se lev els ar e in v olv ed , th e cr ed it h ou r s w ith th e h igh est cost sh all be w aiv ed . Tu ition for In com p letes (I) w ill be p aid on ce th e gr ad e is con v er ted in to th e r equ ir ed p assin g gr ad e. Th e em p loyee m u st m ake r ep aym en t for u n su ccessfu l cou r sew or k w ith in 30 d ays of th e gr ad e n otification by th e Un iv er sity Registr ar . An y em p loyee w ith ou tstan d in g d ebts to FAU w ill n ot be ap p r ov ed for EESP. Paym en t Op tion s: On lin e u sin g you r Master Car d , Am er ican Exp r ess or Discov er Car d . Usin g th e on lin e s ystem , th e th ir d p ar ty v en d or (PayPath ) w ill p r ocess you r p aym en t an d ap p ly it to you r stu d en t accou n t w ith a n on -r efu n d able fee of 2.6%. Or , on lin e u sin g you r Ch eckin g/ Sav in gs accou n t w ith ou t a fee, or Cash ier 's Dr op Box located in th e Boca Raton Stu d en t Serv ices Bu ild in g. (Ch eck or Mon ey Or d er on ly) Th e Un iv ersity is au th or ized to m ak e p ayr oll d ed u ction s fr om th e em p loyee's p aych eck to sa tisfy an y ou tstan d in g b alan ce after 30 d ays. (C) It is th e em p loyee's r esp on sibility to p r ocess th e r egistr ation for m , th e Em p loyee Ed u cation al Sch olar sh ip Pr ogr am for m , an d p ay an y ad d ition al fees d u e at th e Cash ier 's Office by th e p u blish ed d ead lin e. (D) It is th e em p loyee's r esp on sibility to n otify H u m an Resou r ces of an y ch an ges to th is EESP for m befor e th e d u e d ate. Th e on ly classes th at w ill be cov er ed ar e th e on es listed on th is for m . (E) Ad m ission , cou n selin g, r egistr ation , d r op / ad d , r efu n d an d gr ad e p olicies an d p r oced u res for th e em p loyee w ill be th e sam e as for oth er stu d en ts as ou tlin ed in th e Un iv er sity Catalog an d th e Sch ed u le of Cou r ses for each ter m . On ly cou r ses offer ed at th e Boca Raton , For t Lau d er d ale (Tow er ), Dav ie, H ar bor Br an ch , SeaTech , or MacAr th u r cam p u ses ar e eligible for th e Em p loyee Ed u cation al Sch olar sh ip Pr ogr am . Con tr act cou r ses or oth er sp ecial p r ogr am s ar e n ot eligible for th is sch olar sh ip . Em p loyees w ill be r esp on sible for th e ad d ition al cost an d fees associated w ith su ch p r ogr am s as th e Execu tiv e MBA, In ter n ation al MBA, FEEDS an d E -Lear n in g. Qu alifyin g EESP p ar ticip an ts m ay be eligible for a Book Stip en d , p lease see th e p olicy at h ttp :/ / fau .ed u / h r / In ter n al Rev en u e Cod e Section - Paym en ts m ay be for eith er u n d er gr ad u ate or gr ad u ate -lev el cou r ses. Th e p aym en t d oes n ot h av e to be w or k r elated cou r ses. If you r em p loyer p ays m or e th an $5,250 for ed u cation al ben efits for you d u r in g th e year , you m u st gen er ally p ay tax on th e am ou n t ov er $5,250. For m or e in for m ation log on to: h ttp :/ / w w w .ir s.g ov / p u blication s/ p 970/ ch 11.h tm l BILLIN G PROCESS: For sp ecific billin g qu estion s, p lease con tact th e Controller 's O ffice at 561-297-3118.

EESP Form Revised 08-24-17