CICTEP Tuition Exchange Application Form for JCU Employees

If submitting this form for a dependent, before submitting please make sure that you have completed and submitted all requirements to JCU Human Resources. An initial eligibility form must first be submitted, along with any requested documents from HR.

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EMPLOYEE INFORMATION

Employee First Name

Employee Last Name

Employee Banner ID

Employee Email

Number of Years Employed by JCU

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STUDENT INFORMATION

Student First Name

Student Middle Name

Student Last Name

Student SSN (last 4 digits only)

Student Date of Birth

Student Email Address

Student Home Address

Country

Street

City

Region

Postal Code

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APPLICATION INFORMATION

Term in which student is planning to enroll (typically Fall)

Year in which student is planning to enroll

Council of Independent Colleges Tuition Exchange Program (CICTEP) Institutions (for a list of all CICTEP member schools please click here)

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Employee Name/Signature

Today's Date