ࡱ>  pbjbj @t[[[[[ooooo()|PS(U(U(U(U(U(U($*F-y(i[!!!y([[(n&n&n&! [[S(n&!S(n&n&V{'@' \o!:' ?((0()' -"-''-['X ^n&z L y(y(%()!!!!- !:  Application for 50% Waiver of Undergraduate Tuition by a Child of a 7 Year Illinois University Employee Attending SIUE TO BE COMPLETED BY THE STUDENT: Name of the Student (below): SSN: FORMTEXT       Banner ID: FORMTEXT      (Last): FORMTEXT      (First): FORMTEXT      (Middle Initial) : FORMTEXT   Address:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT   Zip:  FORMTEXT      Home phone number:  FORMTEXT     /  FORMTEXT     -  FORMTEXT     Date of Birth:  FORMTEXT    /  FORMTEXT    /  FORMTEXT     1. Are you currently employed by a State of Illinois University? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, in what capacity? Student/GA  FORMCHECKBOX  Faculty  FORMCHECKBOX  Admin/Prof Staff  FORMCHECKBOX  Civil Service  FORMCHECKBOX 2. Name of University you are employed by: FORMTEXT      3. Are you an out-of-state resident?Yes  FORMCHECKBOX  No  FORMCHECKBOX 4. Number of credit hours you are registering for: FORMTEXT   5. Would you attend a State of Illinois University without this waiver?Yes  FORMCHECKBOX  No  FORMCHECKBOX 6. What academic term are you registering for? Fall  FORMCHECKBOX  Spring  FORMCHECKBOX  Summer  FORMCHECKBOX  of  FORMTEXT     7. What University is your parent employed by? FORMTEXT      Is your parent:Faculty  FORMCHECKBOX  Admin/Prof Staff  FORMCHECKBOX  Civil Service  FORMCHECKBOX Is your parent:Currently Employed  FORMCHECKBOX  Retired  FORMCHECKBOX  On Layoff  FORMCHECKBOX Name of employee (parent): FORMTEXT      SSN: FORMTEXT      Banner ID: FORMTEXT       Street Address: FORMTEXT      City: FORMTEXT      State: FORMTEXT   Zip: FORMTEXT      Campus Phone #: FORMTEXT     /  FORMTEXT     -  FORMTEXT     Home Phone #: FORMTEXT     /  FORMTEXT     -  FORMTEXT     Relationship of applicant to employee:Natural Child  FORMCHECKBOX Adopted Child  FORMCHECKBOX  Step Child  FORMCHECKBOX  Statement of Draft Compliance  FORMCHECKBOX  I certify that I am re^6 8 ` n t v ~ ʿzbKChuOJQJ-jhCJOJQJU]^JmHnHu.jehuhuCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^Jhu6OJQJhuhuOJQJhu5OJQJh;{6OJQJh;{56OJQJh;{CJOJQJh% 5OJQJh;{5OJQJh @ B F H J T V j l n x z | jU(jhuCJOJQJU]^J(jghuCJOJQJU]^Jhu6OJQJ(jhuCJOJQJU]^Jhu5OJQJhu5CJOJQJ]^J-jhCJOJQJU]^JmHnHu(j}huCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^J  ( J T | ~  XkdS$$IfTl4%\ J$L@ *04 laf4T$If| ~       : < > R T V Z \ b d x лݤЏݤzݤeݤ(jhuCJOJQJU]^J(jhuCJOJQJU]^J(jhuCJOJQJU]^J-jhCJOJQJU]^JmHnHu(j3huCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^Jhu5OJQJhuOJQJ#x z | b d ٺ٭ٺr`SA"h#2h#26CJOJQJ]^Jh#2CJOJQJ]^J#j hh#2OJQJU#jhh#2OJQJUjh#2OJQJUh#2OJQJ(jhuCJOJQJU]^JhuCJOJQJ]^JhuOJQJ-jhCJOJQJU]^JmHnHu"jhuCJOJQJU]^J(j huCJOJQJU]^J { d $Ifzkd$$IfTl40$H04 laf4T  jkd#$$IfTl4$V%04 laf4ytT d $Ifjkd $$IfTl4$V%04 laf4ytT 468TVrtvprͻͩ͗ͅskYLhuCJOJQJ]^J"jhuCJOJQJU]^JhuOJQJ"h#2h#26CJOJQJ]^J#j"hh#2OJQJU#j"hh#2OJQJU#j!hh#2OJQJU#j5!hh#2OJQJUh#2OJQJjh#2OJQJUh#2h#2CJOJQJ]^Jh#26CJOJQJ]^JpJuzkd$$$IfTl40,$04 laf4T d $If$If&(DFHJpr~ٵ}tٵ_ٵtt(j&huCJOJQJU]^Jhu6OJQJ#jc%hhOJQJU#j$hhOJQJUjhuOJQJUhuOJQJhuCJOJQJ]^J-jhCJOJQJU]^JmHnHu"jhuCJOJQJU]^J(j#huCJOJQJU]^JJLwww d $If$Ifxkd%$$IfTl40,$04 laf4Tr^UU d $Ifkd&$$IfTl4\H$<<*04 laf4THJfhj  ٬ٚوviTv(j+huCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^J#j*hhOJQJU#j%*hhOJQJU#j)hhOJQJUhu6OJQJ#j(hhOJQJUhuOJQJjhuOJQJU#j(hhOJQJU:}} d $Ifxkd($$IfTl40$b 04 laf4T~$&BDFlnΠΎΠ|ΠjaΠO#j/hhOJQJUhu6OJQJ#jm.hhOJQJU#j-hhOJQJU#j-hhOJQJUjhuOJQJU(j;,huCJOJQJU]^JhuCJOJQJ]^JhuOJQJ"jhuCJOJQJU]^J-jhCJOJQJU]^JmHnHu~{{ d $Ifzkd+$$IfTl40:$04 laf4Txo d $If $d $Ifa$zkd,$$IfTl40:$04 laf4Ttzq d $If $d $Ifa$xkd.$$IfTl40:$04 laf4T.02PRnprt|  룖j뵣Rj.j3huhuCJOJQJU]^J-jhCJOJQJU]^JmHnHu(jS2huCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^Jhu5OJQJhu6OJQJ#j0hhOJQJU#j 0hhOJQJUhuOJQJjhuOJQJUtvxzzq d $If $d $Ifa$xkd0$$IfTl40:$04 laf4Tz|xo d $If $d $Ifa$zkd1$$IfTl4p0:$04 laf4T$Lxoco $$Ifa$gdu d $If $d $Ifa$zkd2$$IfTl407 $ 04 laf4T "$&:<>HJLNprëДwДÌbД(j6huCJOJQJU]^J(j5huCJOJQJU]^JhuOJQJ-jhCJOJQJU]^JmHnHu.j4huhuCJOJQJU]^JhuCJOJQJ]^J"jhuCJOJQJU]^Jhu6OJQJhu5OJQJhuCJOJQJ^J LNp^RI d $If $d $Ifa$kd4$$IfTl4\7 \$ 04 laf4T0xoxoxo d $If $d $Ifa$zkd6$$IfTl407 $ 04 laf4T  ",.02LPRThٵt^QIIٵhuOJQJhu6CJOJQJ^J*jhCJOJQJU^JmHnHu%j7huCJOJQJU^JhuCJOJQJ^JjhuCJOJQJU^Jhu6OJQJhu5OJQJhuCJOJQJ]^J-jhCJOJQJU]^JmHnHu"jhuCJOJQJU]^J(jI7huCJOJQJU]^J02R8,# d $If $d $Ifa$kd58$$IfTl4ֈ7 $  *F04 laf4Thjlrtz| "ٺ٭ٺ٭zqz٭\ٺ٭(jq:huCJOJQJU]^Jhu5OJQJhu6OJQJ(j:huCJOJQJU]^J(j9huCJOJQJU]^JhuCJOJQJ]^JhuOJQJ-jhCJOJQJU]^JmHnHu"jhuCJOJQJU]^J(j39huCJOJQJU]^JZ\.nIkd;$$IfTl4\7 d$ -  04 laf4T d $If $d $Ifa$"$&,.46JLNVXZ\  (*,.JLٺ٭ِ|p^p|pLpp#j7=hhOJQJU#j<hhOJQJUjhuOJQJUhu6>*OJQJhu5OJQJhuOJQJ(j];huCJOJQJU]^JhuCJOJQJ]^JhuOJQJ-jhCJOJQJU]^JmHnHu"jhuCJOJQJU]^J(j:huCJOJQJU]^JLhjlnptbHbJbfbhbjbcc,c.c0cLcNcjclcncdddǾǠǞDznjDzzrncrnj@hUh;{jh;{U#j'@hhOJQJU#j?hhOJQJUU#j;?hhOJQJUjh;{OJQJUh;{5OJQJh;{OJQJhu6>*OJQJjhuOJQJU#j=hhOJQJUhuOJQJnptHbcLcd^YQYYHCd d `$d a$d kd#>$$IfTl4\&$bb04 laf4Tgistered with the Selective Service  FORMCHECKBOX  I certify that I am not required to register with the Selective Service because:  FORMCHECKBOX  I am female.  FORMCHECKBOX  I am in the Armed Services on active duty. (NOTE: Does not apply to members of the Reserves and National Guard who are not on active duty.)  FORMCHECKBOX  I have not reached my 18th birthday.  FORMCHECKBOX  I was born before 1960.  FORMCHECKBOX  I am a citizen of the Federated States of Micronesia, or the Marshall Islands or a permanent resident of the Trust Territory of the Pacific Islands (Palau).  FORMCHECKBOX  I am an international student (applicable only to State of Illinois funded programs.)  FORMCHECKBOX  I am an incarcerated student. I declare under penalty of perjury that the information on this application is true and correct. As a recipient of a tuition waiver award from Southern Illinois University, I understand that the University has the legal authority to release my name and address, the name of my former high school or college, the name of my award, and the award amount. This release is valid for the period of time the tuition waiver is in effect. The refusal to accept this agreement will result in a forfeit of the waiver. Applicant Signature:Date: PLEASE NOTE: To avoid being incorrectly billed, students should register BEFORE completing this form. Tuition waiver request forms are due in the Office of Human Resources by the 10th day after the official start of the semester. Tuition waiver request forms received after the deadline will not be processed. 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