oakland university tuition reduction â application & affidavit of taxability

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OAKLAND UNIVERSITY TUITION REDUCTION – APPLICATION & AFFIDAVIT OF TAXABILITY PART III – STUDENT INFORMATION (IF EMPLOYEE IS NOT THE STUDENT) Relationship to Employee ________________________________________________________________________ Name__________________________________Date of Birth___________________Grizzly ID_________________ PART IV – COURSE DATA Degree__________________________________Area of Specialization____________________________________ Certificate Granting Program _________________________________ Start Date ___________________________ Completion Date ____________________________________________ Amount ____________________________ Student will attend (please check one): Year ___________ Level (please check one): O Fall O Undergraduate FR/SO O Winter O Undergraduate JR/SR O Summer 1 O Graduate O Summer 2 O Other Course Title & Name Course# Credits Class Meeting Day/Time I authorize the Human Resources Office to verify evidence of my grades for classes taken at Oakland University for the semester(s) for which the tuition benefit was paid. Student Signature_______________________________________________________Date_________________ STAFF ONLY. The course(s) listed above are held during my regular work schedule: O YES O NO If yes, please specify the hours in class ___________________________________________________________ 2
OAKLAND UNIVERSITY TUITION REDUCTION – APPLICATION & AFFIDAVIT OF TAXABILITY PART V – AFFIDAVIT OF TAXABILITY This affidavit must be completed by all employees requesting TUITION REDUCTION (TR) to determine whether Oakland University must treat the requested TR as taxable income to the employee under Federal Internal Revenue regulations. In most cases, TR is not taxable for undergraduate courses taken by an employee or by a spouse or child who qualifies as the employee’s dependent under federal tax law. In addition, specific IRS rules govern the taxability of TR for graduate education, OQA and their children, and children of divorced and separated parents. This affidavit is necessary to comply with federal tax law and to protect you and Oakland University from potential tax liabilities and penalties. To complete the affidavit, read the following statements and INITIAL any statement that applies to you. 1. UNDERGRADUATE TUITION REDUCTION FOR SELF, A SPOUSE, OR OQA If you are seeking TR for your own education or that of a spouse, or OQA, initial ALL applicable statements: ____ I certify that I am applying for my own education in courses BELOW the graduate level and I understand that undergraduate tuition benefits are not taxable to university employees. ____ I certify that the person for whom I am requesting TR: (a) is my spouse and that we have entered into a marriage recognized under federal tax law, and we are not estranged, and that he/she does not maintain a separate domicile. ____ I am seeking TR for an OQA and I understand that 100% of the value of the TR is taxable income to me. 2. UNDERGRADUATE TUITION REDUCTION FOR AN EMPLOYEE’S CHILD OR A DEPENDENT OF AN OQA A. If you are seeking undergraduate TR for a child whom you WILL CLAIM as a dependent on your income tax return for the year 20___, initial the following: ____ I certify that the person for whom I am requesting TR is a child that I intend to claim as my dependent on my federal income tax return for the 20___ calendar year. If I do not claim my child as a dependent on my income tax return for the 20___ calendar year as indicated above, I WILL NOTIFY the HR Office as soon as possible and no later than November 15 th . I understand that the value of the TR will be rescinded and I agree to be liable for all charges. B. If you are seeking undergraduate TR for a child, as a divorced or separated parent, whom you WILL NOT CLAIM as a dependent on your income tax return for the year 20___, initial the following: ____ I do not intend to declare my biological child, stepchild or legally adopted child as a dependent on my federal income tax return for the 20___ calendar year and: (a) I am currently divorced or separated from the child’s parent; (b) My child’s other parent will claim the child as a dependent on his/her federal income tax return for the 20___ calendar year; and (c) My marriage to the other parent was one that is recognized under federal law, (i.e., not an other qualified adult). If the child’s other parent does not claim my child as a dependent for this tax year, I WILL NOTIFY the HR Office as soon as possible and no later than November 15 th . I understand that the value of the TR will be rescinded and I agree to be liable for all charges. 3
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