Date Fill in the date that you are filling out the form Scan and email the form to careyexecedjhuedu Academic Term Options Select Fall Q1 ampQ2 2015 Telephone Work phone number SS ID: 583096
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Tuition Remission InstructionsSlide2
Date
Fill in the date that you are filling out the formScan and email the form to carey.execed@jhu.edu Academic Term OptionsSelect Fall (Q1 &Q2) 2015Telephone#Work phone number SS#Social Security NumberLast 4 digits are acceptable JHED IDEmployee NameEmployee Full Name Employment DateStart date of your current employment Dept. Code.Department code Refer to your E-210 formSlide3
Course Number
Do not fill in this boxCourse TitleFull title of the specific seminar you are takingCourse Cost Factor in 20% discountCourse TypeNon-Credit-Professional DevelopmentCourse OfferedCarey-Executive-Continuing Programs-100%SignatureNeed to print out the document to sign Slide4
Department Budget Number
This budget number is required and will be charged only if (1) the participant cancels within one week of the program start date, or (2) fails to attend, or (3) is otherwise found to be ineligible for the tuition benefit.In any of these circumstances, the department is liable for the course fee.Supervisor or Department Head SignatureNeed to print and signHR Approval for RetireesOnly applies if the application is for a retiree