The University of Memphis

Request for Departmental Tuition Waiver

Submit e-mail completed form to the bursar_ar@memphis.edu OR fax to (901) 678-0288 OR deliver to 115 Wilder Tower.

This form should be used to request tuition/fee waivers to be paid by department and/or grant index.

Please allow 3-5 business days from date received in Bursar's Office for processing requests. Please check the Bursar's Web site for the fee payment deadlines for each term. Completed form can be faxed to 901-678-0288 or e-mailed to bursar_ar@memphis.edu. (Form should be scanned & attached to email.) For best results, printing should be done with landscape format.


TO BE COMPLETED BY DEPARTMENT
Term (Ex: Spring 2014) Student Name Student U# Maximum Amount of Waiver Index To Be Charged for Waiver Fund Org Account Program Student UM Employee? Y/N

Requested By: Department: Date:
Requester Phone #:


Approver: Approver Phone #: Approver Signature:__________________________________


(This person must be listed as an Authorized Signature for the org, and approver must sign in order for this form to be processed by Bursar's Office)

NOTES:



Please e-mail the completed form to bursar_ar@memphis.edu.
  Bursar's Office Use Only


Received on (date) _____________________________ Processed (initial and date) _______________________________

The University of Memphis, one of the Tennessee Board of Regents institutions, is an Equal Opportunity/Affirmative Action University.