Student Name:

Applicant is: Employee Spouse Same Sex Domestic Partner Child*

Student UR ID #:

  Year (Fall/Spring) Fall Spring May June July

For what academic year is student applying?  

Student Date of Birth:

Does student have an undergraduate degree? Yes No

Student is: Part-time Full-time

If part-time, list courses below:
Course: #Units/Credit
Course: #Units/Credit

Employee Name:

Date of Employment:

Employee UR ID #:

Employee Status:
Tenure/Tenure Track Faculty
Term Contract Faculty
Staff (38.75 hours or more per week)
Staff (less than 38.75 per week)

This application will be reviewed based on existing University policies regarding tuition remission benefits for staff or tuition remission benefits for faculty. Employees must reapply for this benefit at the beginning of each term unless they are a full-time student and apply for both fall and spring semesters at one time. This is not a class registration form.  Employees must register for classes separately.

Failure to submit your tuition remission form by the first day of the term will result in a late fee being applied to your account. You will be responsible for the payment of this fee. Fees may be found on the Controller's web page.

Full-time students who are Virginia residents MUST apply for the Virginia Tuition Assistance Grant (VTAG) by July 31. Tuition remission does not cover the amount of VTAG. Contact the Financial Aid Office for more information.

Tax Implications (as of 9/24/18)

According to IRS regulations, tuition remission for employees, spouse, and dependents that do not have an undergraduate degree is not taxable. Tuition remission for same sex domestic partners and their dependent children, regardless of whether they have an undergraduate degree, is considered taxable income. 

Applicable federal, social security, Medicare and state taxes on the taxable tuition remission benefit value will be withheld from employee pay. The taxable benefit amount is added to the employee’s taxable income over a series of paychecks and additional tax is withheld. The benefit amount will be taxed at the supplemental tax rate: 22% Federal, 1.45% Medicare, 6.2% Social Security, and 5.75% Va. State. This is a combined tax rate of 35.4%. As an example, if an employee has already met the $5,250.00 threshold and will be taking a class with a tuition of $1,800, the total tax will be $637.00. It is in the employee's best interest to fully understand the tax implication. Employees should consult with their professional tax advisor if further guidance is needed.   

I acknowledge that I have read and understand both the Tuition Remission policy and the Tax Implications.

I certify that to the best of my knowledge and belief all of the information on this form is correct.