TUITION REMISSION BENEFIT FORM
Last Revised: Spring 2007

Employee Name ____________________________________Social Security # ______________________________

Home Phone # (        )_________________________________UNM ID Number (Required)______________________

Mailing Address (include city and zip code)____________________________________________________________

_____________________________________________________________________________________________

Department________________________________________________________ Work Phone #_________________

E-mail Address_______________________________________________________________

Employment Status: Faculty ____ Staff ____ Retiree____ Session: Year_____ Fall ____ Spring ____ Summer _____

Note: Tuition Remission is applicable to regular employees with .5 FTE or greater.
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THIS SECTION FOR EMPLOYEE AND/OR SPOUSE/DOMESTIC PARTNER

I. CREDIT COURSES: Complete this Section and Section IV-Certification. Submit the form to the Bursar's Office or CNM Registration Office. Non-degree students may submit this form to UNM Continuing Education. Supervisory approval (Section III below) is required only if time off from your normal work schedule is involved.

EMPLOYEE:

SPOUSE/DOMESTIC PARTNER:  Check one: Spouse ____ Domestic Partner ____
Spouse/Domestic Partner Name _____________________________________________________ Spouse/Domestic Partner Soc Sec Number (Required) _______________________________________UNM ID Number (Required)_____________________________________________________

THIS SECTION FOR EMPLOYEE ONLY

II. NON CREDIT COURSES: Complete this Section and the Certification Section IV. Obtain supervisory approval if applicable, and submit form to UNM Continuing Education or the specific department offering the course. Other University departments that accept the Tuition Remission Form as payment include Anderson Schools, Continuing Medical Education, and Human Resources Employee and Organizational Development. Use a separate form for each location. Non credit courses that are for professional development or improvement of work related skills REQUIRE supervisory approval.

PROFESSIONAL DEVELOPMENT (MUST BE WORK RELATED):

PERSONAL ENRICHMENT OR NON WORK RELATED PROFESSIONAL DEVELOPMENT (SEE SECTION IV BELOW):

III. SUPERVISORY APPROVAL
Complete this Section to obtain supervisory approval only if the credit or non credit course(s) listed above is/are offered during your regular work schedule. Supervisory approval is also required if a non credit course qualifies as work-related and is therefore not subject to the two (2) credit hour limitation per calendar year. Supervisors are encouraged to grant employees time off with pay to attend one (1) credit course each semester if the course is related to the employee's work or to a University position to which the employee reasonably aspires and if the course is not available outside regular work hours. Time off with pay must be granted when a course is required by the supervisor. In some circumstances, time off may be granted but is made up during the work week. For additional information in these cases, see Section 5.1. of "Tuition Remission Program" Policy 3700, UBP. Check applicable spaces:

_____ Time off with pay is granted _____ Time off is not granted

_____ Time off is granted but must be made up as follows:____________________________________________________________________________

_____ Verification of all work related non credit courses.

Supervisor_______________________________________________ Manager/Dept. Chair _________________________________________________
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IV. EMPLOYEE CERTIFICATION
I certify that this request is within the maximum allowable benefit per semester as provided in the "Tuition Remission Program" Policy 3700, UBP of no more than eight (8) credit hours in fall and spring semester and no more than four (4) credit hours during summer. Personal development non credit courses do not exceed the equivalence of resident, undergraduate tuition for two (2) credit hours per calendar year. Tuition rates can be viewed at http://www.unm.edu/%7ebursar/tuitifall04.html.

I understand that I am responsible to repay all costs that exceed the maximum allowable benefit, which UNM may collect through payroll deductions. I certify that this request complies with the "Tuition Remission Program" Policy 3700, UBP and that the information provided above is true.

Employee ____________________________________________________________________ Date__________________________________________

Comments may be sent to UBPPM@UNM.edu
http://www.unm.edu/~ubppm