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DEPENDENT FEE WAIVER CERTIFICATION

DEPENDENT FEE WAIVER CERTIFICATION 2026

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The document is a certification form for employees at Cal Poly Pomona to transfer their fee waiver eligibility to their dependents, including spouses, domestic partners, or children. It outlines the necessary employee and dependent information, eligibility criteria for dependents, enrollment details, potential tax implications of using the waiver for graduate coursework, and instructions for submission. The form must be completed and submitted to HR for approval.

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Click ‘Get Form’ to open the DEPENDENT FEE WAIVER CERTIFICATION in the editor.
Begin by filling out the EMPLOYEE INFORMATION section. Enter your last name, first name, job title, department, and on-campus telephone number. Ensure that your employment status is accurately selected as either probationary/permanent or temporary.
Next, provide your Bronco number and email address. This information is crucial for processing your waiver request.
In the WAIVER TRANSFER section, input your dependent’s name and relationship to you (spouse, domestic partner, or dependent child). Include the child’s birthdate if applicable.
Specify the major/program of study and select whether it is undergraduate or graduate/credential. Indicate the term(s) of enrollment for which you are requesting a waiver.
Complete the IMPUTED TAX section by acknowledging potential tax consequences if applicable. Finally, sign and date the EMPLOYEE CERTIFICATION & SIGNATURE section before submitting your form.

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