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Zane State Employee Request Form

ZANE STATE EMPLOYEE REQUEST FOR REGISTRATION AND

WAIVER OF TUITION AND FEES AT OHIO UNIVERSITY-ZANESVILLE  

 

INSTRUCTIONS

Registration for a course at Ohio University-Zanesville must be processed through the Registration Office.

Zane State employees are not permitted to register through TRIPS or Web Registration to be eligible for

the Zane State Employee fee waiver at Ohio University-Zanesville.

 

APPLICANT INFORMATION (Please print or type)

 

Date  _________________________________

 

Name ___________________________________________________________________________________

                     Last                                       First                          Middle                               Maiden

 

SSN or OU PID____________________________________       Phone Number  ___________________

 

Date of Birth ______________________________________         Place of Birth _____________________

 

Resident of Ohio  Yes  No               If yes, which county?  ________________________________

 

Have you taken previous coursework at OUZ? _____  If yes, when?_____________________

 

COURSE INFORMATION

 

TERM__________________              YEAR _________________________

 

 

CALL #

DEPT

COURSE #

SECTION

CREDIT HOURS

 

 

 

 

 

 

 

 

ZANE STATE EMPLOYMENT INFORMATION

 

POSITION ________________________________________________________________________________

 

    FULL-TIME                 PART-TIME             ______ HOURS PER WEEK

 

Please note: Fee waiver does not cover special lab or course related fees.

 

 

 

SIGNATURE ________________________________________              DATE ________________________

 

Please return this form to the Registration Office at Ohio University-Zanesville.

Fee waivers will be processed upon registration and employment verification.

 


Office Use Only

 

Registration       Date_________                Initials _________

 

Fee Waiver         Date_________                Initials _________                           Amount_____________________________________