Staff Educational Tuition Assistance – Interest Free Loan Application and Promissory Note for Loan Re-Payment 1. The applicant is to complete Section A, B, C and D with the appropriate signatures and submit to Human Resources at least 3 weeks before tuition payments are due. 2. If this application is approved, the College agrees to provide an interest-free loan to the employee, not to exceed the amount of the actual tuition fees for each credit course/program. 3. Human Resources will return any incomplete forms to the applicant. 4. Payroll will approve the application and process on the next available pay date. Application Date: SECTION A: APPLICANT INFORMATION (TO BE COMPLETED BY THE APPLICANT) Applicant Name Phone Position E-mail Staff ID # Please check the appropriate box ☐Administration ☐ Faculty ☐Support SECTION B: COURSE INFORMATION (TO BE COMPLETED BY THE APPLICANT) Name of Educational Institute Address Course Name and Number Student Number if available (Please attach course description) Course Tuition Fee Course Start Date: Course End Date: SECTION C: RE-PAYMENT AGREEMENTS BETWEEN THE EMPLOYEE AND MOHAWK COLLEGE In applying for tuition assistance interest free loan: 1. I understand that my tuition loan will be repaid to Mohawk College as indicated in the promissory note below 2. My employer, Mohawk College, shall and is hereby authorized to make deductions as indicated in the promissory note below 3. I understand, and agree, that on any payroll date during the term of this agreement, I may, if I wish, pay the loan off in its entirety. I understand that partial payments are not allowed. 4. I understand, and agree, that in the event of termination of my employment with Mohawk College for any reason, including death, the balance of the outstanding loan at the time shall immediately become payable, and Mohawk College is hereby authorized to deduct this from my final pay and in the event my final pay is not sufficient to cover the balance, I, or my estate shall pay the outstanding balance to Mohawk College due immediately upon notification. 5. In the event that payroll is suspended (i.e.: unpaid leave of absence), I shall make arrangement with the College to cover the payments that I would otherwise have made for the time period involved. 6. I understand, and agree, that in the event I withdraw from the academic institution, it is my sole responsibility to negotiate reimbursements with the academic institution. Mohawk College will continue to deduct the agreed upon amount of my tuition from my pay until full payment has been made. 7. I understand that the money borrowed from Mohawk College is considered an interest free loan and therefore is a taxable benefit under current income tax legislation. The taxable benefit calculation is based on Canada Revenue Agency’s prescribed rate and will appear on my T4 slip. The taxes associated with this benefit will be deducted on each pay for the duration of the loan. Human Resources Signature Dated Processed by Human Resources: 1 SECTION D: EMPLOYEE PROMISSORY NOTE I, _________________________________________________ promise to pay to Mohawk College, the total amount of $ __________ and this amount will be paid through my bi-weekly (semi-monthly) payroll deductions, over 8 pay periods, in the amounts of $__________ per pay, effective the next available pay date until paid in full. Applicants Signature Witness Signature Witness’s Name (Please Print) Date: Authorized by: Manager, Payroll Services SECTION E: FOR PAYROLL SERVICES ONLY ((TO BE COMPLETED BY THE PAYROLL) Repayment Plan Total Tuition Loan $__________ / 8 Pay Periods = Total Deduction per Pay __________ Pay Period Commencing: ____________________ Through to Pay Period Ending: ____________________ Payroll Officer Name Signature Date 2