The University of Memphis

Request for Departmental Tuition Assistance

Submit completed form via the form upload at https://umwa.memphis.edu/topdesk/index.php/usbs/index.

This form should be used to request tuition/fee assistances to be paid by department and/or grant index. Beginning Fall 2021, this form is for undergraduate students only! For Graduate student tuition assistance, please submit Graduate Scholarship request thru the eContract online request system at https://www.memphis.edu/econtract.

Please allow 3-5 business days from date received in University & Student Business Services for processing requests thru the scholarship office. Please check the USBS Web site for the fee payment deadlines for each term. Completed form can be 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 2020) 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 USBS)

NOTES:



Submit completed form via the form upload at https://umwa.memphis.edu/topdesk/index.php/usbs/index.
  USBS Use Only


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

The University of Memphis is an Equal Opportunity/Affirmative Action University.