<p> NICHOLLS STATE UNIVERSITY UNIVERSITY OF LOUISIANA SYSTEM FACULTY, STAFF AND DEPENDENTS FEE EXEMPTION POLICY</p><p>The exemption policy became effective at our University for the Fall1982 semester. The revised policy became effective March 4, 2013.</p><p>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 </p><p>QUALIFYING FACULTY, STAFF AND DEPENDENTS SHALL BE EXEMPTED AS INDICATED BELOW. FACULTY / STAFF / DEPENDENT FEE EXEMPTION AMOUNTS – SUBJECT TO CHANGE</p><p>SPRING 2015</p><p>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</p><p>Office code: ______(for Controller’s Office use only) </p><p>EMPLOYEE NAME: ______ID #______FACULTY STAFF (check one)</p><p>SEMESTER REGISTERING FOR: PHONE #: ______</p><p>FULL-TIME EMPLOYMENT: YES NO </p><p>PERSON FOR WHOM EXEMPTION IS BEING CLAIMED (check one)</p><p>SELF UNDERGRADUATE GRADUATE ------DEPENDENT SON/DAUGHTER SPOUSE UNDERGRADUATE </p><p>SPOUSE NAME ______ID# ______(if exemption is for spouse)</p><p>DEPENDENT NAME**** ______ID#______DATE OF BIRTH ______</p><p>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.</p><p>I CERTIFY THAT THE FOREGOING INFORMATION IS CORRECT. X______07/02/2014 Signature of Faculty or Staff Member</p>