Tuition Assistance Repayment Agreement

Tuition Assistance Repayment Form

Use this form to reimburse the Johns Hopkins University (JHU) for an overpayment of tuition assistance as outlined in the Tuition Assistance Policy.

Name(Required)

First Last

Personnel Number (PERNR)

This can be found on the upper right corner of your pay statement labeled “Employee Number”. If you cannot find this or you are unsure, please leave this field blank.

JHU Email Address(Required)

EdAssist Application Number(Required)

Total Amount Owed(Required)

Over how many pay periods would you like to repay the amount owed (not to exceed 6 months)?(Required)

Faculty and staff may spread repayment across no more than 12 (semi-monthly) pays. Bargaining Unit members may spread repayment across no more than 24 (weekly) pays.

Amount Deducted Per Pay(Required)

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Cost Center

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Wage Type

Pay Date to Begin Deductions

If you leave this field blank, deductions will begin on the next available pay cycle.

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