University Employee Registration Form

Professional Development Course Registration Form for University Employees
University of Chicago Affiliation*
Employee Information
Other Affiliation(s):
Name*
UChicago Email*
example@uchicago.edu
Home Address, City and Zip:*
Work Address:*
Department:*
Job Title:*
Home Phone:*
Please enter a valid phone number.
Work Phone:*
Please enter a valid phone number.

Professional Development Course Registration Form for University Employees
Course Information
Course Title:*
Course Code:*
Section Number:*
Start Date:*

MonthDayYear
Date
Full Tuition:*
Course Title:
Course Code:
Section Number:
Start Date:

MonthDayYear
Date
Full Tuition:
Course Title:
Course Code:
Section Number:
Start Date:

MonthDayYear
Date
** Revised UCPE Tuition Policy is effective December 18, 2017.

For additional information, please visit UChicago Staff Tuition Benefits.
Full Tuition:
Course Information for ClickUP

Professional Development Course Registration Form for University Employees
Tuition Payment Options for Employee 50% (please complete all the required fields)

Option 1: Department pays 50% of tuition ( Please consult with your supervisor before choosing this option. Prior supervisor approval is required for this option.)
Select an Option*
Option 2: Employee pays 50% of tuition

UCPE will contact you for payment details. We accept payment by check, money order, Visa®, MasterCard®, American Express®, or Discover®. Please provide a daytime number below:
*Option 3: Employee and Department split the remaining 50% of tuition (department chair/supervisor approval needed; enter split amounts in the appropriate fields).

Split Amount:
Split Amount:*
Paying Department:*
Chart of Accounts (COA) number to be charged to the Paying Department (Requires departmental/supervisor approval):*
Daytime phone number*
Please enter a valid phone number.
Please indicate which of the following is correct: *
Please check one or more of the following:*

The course(s) will not be used to fulfill minimum requirements of my job.The course(s) are part of a program of study that will qualify me for a new trade or business.Neither of the above is correct. A course will be considered to be job-related if both of the above conditions are met.
*Department Chair or Supervisor Approval for Submission
Supervisor Name:*
Supervisor Email:*
example@uchicago.edu
Employee Signature*

Clear
Acknowledgement*

I acknowledge that once I click "Submit", this is a complete version of my application and I have the prior approval of my supervisor. Please note this submission will copy to the supervisor's e-mail named above to confirm their approval before processing. I also acknowledge, this information is submitted to enable the University to determine whether to withhold taxes from tuition remission for graduate level courses. I understand that the taxability of tuition remission for any course is subject to final determination by the IRS, and that I will be responsible for the payment of all taxes judged by the IRS to be owed by me.
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