Tuition Waivers are issued to the direct social work supervisor (Field Instructor or day-to-day Task Supervisor). The waiver must be submitted at the end of the completed semester for which it was earned.

● SUBMIT ONE FORM FOR EACH STUDENT YOU SUPERVISE.
● Each Tuition Waiver Certificate shall be valid for courses commencing within twenty-five (25) months of the effective date.
● The effective date for calculating the date the certificate expires is the beginning of the next academic term immediately following the academic term in which the service was rendered.
● May be used at any SUNY institution.
● Not accepted by all SUNY programs.
● Not accepted at community colleges.
● Eligibility for tuition waiver credit levels is based on the number of credits students earn for field work.
● A signature is required verifying the recipient understands that there is a tax burden once the waiver is issued -- not when it is used.

You must complete TWO steps to request a tuition waiver.

STEP 1: Complete (and submit) this form. Do this NOW.

You have accepted the offer of a tuition waiver. A signature is required verifying you understand that there is a tax burden once the waiver is issued -- not when it is used.

Please review the Social Work Tuition Waiver Policy.

Field Instructor: You have declined the offer of a tuition waiver. A signature is required verifying you authorize this waiver request form be provided to the field task supervisor.

STEP 2: Send us your Social Security Number (SSN). Do this AFTER submitting this form.
            (applies to person requesting waiver)

Upload a file with your SSN to the SUNY Brockport secure dropbox (this link opens in a new window).

Acceptable file types are:

● A scan or photo of your SSN card
● A Word document containing your SSN, name, and agency.

Your SSN is needed for reporting purposes because the Social Work Tuition Waiver is taxable as income in the year it is issued. A 1099 will be issued to you by New York State.

SUNY Brockport and our third-party provider, Microsoft, are dedicated to protecting your personal information. Any sensitive information entered into the SUNY Brockport secure dropbox is encrypted during transit and while at rest. When authorized personnel retrieve your information from the database, the same level of security is used. If you have any questions or concerns, please contact SUNY Brockport IT Service Desk at 585-395-5151.

Field Instructor - Save a draft of this form so the task supervisor can complete and submit it:
     1.  Check the below box next to "Save my progress and resume later".
     2.   Enter the task supervisor's email address when prompted.
     3.  Click on the "Save form and resume later" button.
     4.  An email with the subject "Your draft Tuition Waiver Request" will be sent to the task supervisor. This email contains a "Resume" link and directs the supervisor to review, sign, and submit this form.

Task Supervisor - Complete and submit this form:
     1.  Click on the the "Continue" button.
     2.  Complete and submit this form.
     3.  You will receive an email notification when your request is approved.

Next steps:
     1.  Click on the the "Continue" button to complete and submit this form.
     2.  You will receive an email notification when your request is approved.