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Johns Hopkins University Human Resources
Tuition Assistance Repayment Agreement
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 labelled “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)
Hidden
Cost Center
Hidden
Wage Type
Pay Date to Begin Deductions
MM slash DD slash YYYY
If you leave this field blank, deductions will begin on the next available pay cycle.
Consent to Repayment via Payroll Deduction
(Required)
By checking this box, I agree to the payroll deductions as outlined in this form. This serves as my digital signature.
I agree that I must reimburse the Johns Hopkins University (JHU) for an overpayment of tuition in the amount noted in this form. To satisfy the overpayment, I hereby authorize JHU to make the payroll deductions as outlined in this form.
In the event I leave JHU before this is fully repaid, the remaining overpayment balance will be withheld from my final pay.