ࡱ> 140 bjbjΣΣ 4jj &&3338k3!zzzbzX"zzzhhhzFhzhhhVG8(h0!hRhhHzzhzzzzz:.zzz!zzzzzzzzzzzzz& :  STAFF TUTION SCHOLARSHIP PROGRAM HOCKING COLLEGE Registrant Information: Semester(s) of Enrollment: Current employees and their spouse, children and grandchildren* must complete a scholarship request form each semester. Any form received after the semester is over will not be applied. Name (Print): Student ID: Relationship to Employee/Retiree: Employee/Retiree Spouse Child Grandchild* *Grandchildren eligible up to age 23. If grandchild, please indicate date of birth: Employee Information: Name: Employee ID: Department: Position: Employment Status: Full-time Retiree Please note: Full-time, regular employees are eligible for Staff Tuition Scholarship Program after one (1) year of employment. Temporary, part-time and student employees are not eligible. Information regarding the Education Benefits Program: All course fees (with the exception of program fees), fines and penalties are the responsibility of the registrant. Participants will also be required to pay all other student processing fees charged by the College. Each participant, other than the employee, will be assessed a service fee of $10.00 per semester. The Tuition Scholarship Program is for 51 credit classes only. The Tuition Scholarship Program is only available for one (1) completed degree per registrant. Courses that require tuition payment to institutions other than 51 are not eligible for the scholarship (Example: COTC, Tri-County, etc). This program does not cover continuing education courses. The employee/registrants signature verifies that the individual indicated is qualified employee or spouse/child/grandchild and is eligible for the Staff Tuition Scholarship Program. The employee/registrant understands that they will be responsible for all fees not covered under the scholarship program and will repay the College for tuition costs should misrepresentation occur. The employee/registrants signatures also verify the understanding that if the employment agreement is terminated for any reason, the tuition scholarship benefit will be discontinued. I understand the terms of this Staff Tuition Scholarship Program and certify that the above information is correct. Registrant Signature: Date: Employee Signature: Date: Supervisor Signature: Date: This Section to be completed by Human Resources This is to verify that the employee/registrant identified above is eligible for the Staff Tuition Scholarship Program. 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