Employee/Spouse Development Application
Up to Four (4) Free Undergraduate Credits
Policy: For more information on this program, please see Section 3.20.02 (Employee Spouse Free Credits
at Messiah College) or Section 3.20.03 (Staff and Administrative Employee Development) in the
Employee Policy & Procedure Manual.
Employee Name:
ID#:
Spouse Name:
ID#:
(only if spouse applying for free credits)
Department:
Applying for:
Hire Date:
# free credits
Name of school attending:
; Other
; # audited credits
Messiah
Beginning Date:
Other
Estimated Completion Date:
Name of Course:
Employee Signature ______________________________________________
Date
Spouse Signature ________________________________________________
Date
(only if spouse applying for free credits)
SUBMIT INVOICE TO HUMAN RESOURCES FOR OFF-CAMPUS COURSES
Necessary Approvals:
Immediate Supervisor ____________________________________________
Date ______________
Account to be charged if off campus ______________________________________________________
Department Head ________________________________________________
Date ______________
Admissions Office _______________________________________________
Date ______________
(signature of Admissions designee for Messiah College courses only)
Registrar _______________________________________________________
Date ______________
(signature of Registrar or designee for Messiah College courses only)
Messiah College does not discriminate on the basis of age, race, color, sex, national or ethnic origin, disability, or veteran’s status
in the recruitment and admission of students, the recruitment and employment of faculty and staff, or the operation of any of its
programs.
FOR HUMAN RESOURCES USE ONLY:
Approved by:
Academic term: Summer _______
Document1
Date:
Fall _______
Spring _______
Cost: $
Revised 01/2015