Intent to Apply for Tuition Remission

If you are a Goucher College faculty or staff member who intends to apply for the college’s Tuition Remission benefit on behalf of a dependent child who has applied to the undergraduate program, please complete this form. Information submitted through this form will be shared with the Office of Undergraduate Admissions and the Office of Human Resources.

Please review the Tuition Remission, Reimbursement, and Exchange Policy to confirm eligibility prior to submitting this form. If you have questions about your eligibility, please contact the Office of Human Resources at hr@goucher.edu.

Note: Submission of this form does not replace the Tuition Remission Application that must be completed at the start of each semester and submitted to the Office of Human Resources in order to confirm benefit eligibility and issuance.

Student Information

Student's Legal First Name

Student's Legal Last Name

Student's Date of Birth

Student's Email Address

Intended Year & Term of Enrollment

Student Type

Employee Information

Employee First Name

Employee Last Name

Employee Department

Employee Email Address