Nicholls State University

NICHOLLS STATE UNIVERSITY UNIVERSITY OF LOUISIANA SYSTEM FACULTY, STAFF AND DEPENDENTS FEE EXEMPTION POLICY

The exemption policy became effective at our University for the Fall1982 semester. The revised policy became effective March 4, 2013.

The revised policy can be found in the Nicholls State University Policy and Procedure Manual which can be found at http://www.nicholls.edu/documents/nicholls/NSU_Policy_Procedures_M.pdf -Tuition Waiver or at the University of Louisiana System website at www.ulsystem.net

QUALIFYING FACULTY, STAFF AND DEPENDENTS SHALL BE EXEMPTED AS INDICATED BELOW. FACULTY / STAFF / DEPENDENT FEE EXEMPTION AMOUNTS – SUBJECT TO CHANGE

SPRING 2015

This form must be received by 1/16/15 to ensure processing before fee deadline. HOURS UNDERGRAD UNDERGRAD GRADUATE SCHEDULED FAC/STAFF DEPENDENT FAC/STAFF 1 $851.45 $744.45 $930.80 2 $880.45 $744.45 $959.80 3 $909.45 $744.45 $988.80 4 $1,126.60 $932.60 $1,232.40 5 $1,343.75 $1,120.75 $1,476.00 6 $1,560.90 $1,308.90 $1,719.60 7 $1,560.90 $1,497.05 $1,719.60 8 $1,560.90 $1,685.20 $1,719.60 9 $1,560.90 $1,873.35 $1,719.60 10 $1,560.90 $2,061.50 $1,719.60 11 $1,560.90 $2,249.65 $1,719.60 12 & OVER $1,560.90 $2,437.80 $1,719.60 ------COMPLETE ONE FORM FOR EACH ELIGIBLE PERSON FOR EACH SEMESTER

Office code: ______(for Controller’s Office use only)

EMPLOYEE NAME: ______ID #______FACULTY STAFF (check one)

SEMESTER REGISTERING FOR: PHONE #: ______

FULL-TIME EMPLOYMENT: YES NO

PERSON FOR WHOM EXEMPTION IS BEING CLAIMED (check one)

SELF UNDERGRADUATE GRADUATE ------DEPENDENT SON/DAUGHTER SPOUSE UNDERGRADUATE

SPOUSE NAME ______ID# ______(if exemption is for spouse)

DEPENDENT NAME**** ______ID#______DATE OF BIRTH ______

IS DEPENDENT CLAIMED ON YOUR CURRENT TAX RETURN? YES NO (check one) **** The name that is listed as a dependent must meet the same requirements as a dependent reported on your current income tax return or reflect your current year tax status. Proof may be required.

I CERTIFY THAT THE FOREGOING INFORMATION IS CORRECT. X______07/02/2014 Signature of Faculty or Staff Member