Paperwork must be submitted once per academic year.

• Education Benefit Request Form for Eligible Retired Employees for the University of Pittsburgh (via DocuSign)

The education benefit will only be applied for the terms listed on the Education Benefit Request form for the University of Pittsburgh. If the student will be studying abroad or participating in a co-op program, please notify the Benefits Department to ensure the benefit processes on these tuition charges.

Submission of Required Documentation

To submit your request form and related documentation:

1. Access the Education Benefit Request Form for Eligible Retired Employees (via DocuSign).
   • This form and related documentation must be submitted once per academic year.
2. Enter your name and valid email on the form.
3. After selecting "Begin Signing," you will be sent an access code to the email you entered. You must enter the access code you received to complete signing the form.
4. Enter all required information on the form, including attaching any related documentation.
5. Review your information. Once all information is entered and the form is signed, please select "Complete" from the DocuSign toolbar (at the top of the page).

Forms are processed by the Benefits Department within 1-2 business days. Please do not contact the Benefits Department about the status of your form unless it has been more than 3 (three) business days since you have submitted it for processing. After your form is processed, you will receive an email from DocuSign:

• If your form has been "Completed" and you have received an email from DocuSign saying "Completed" in the subject line: The benefit has been approved and will be processed. No further action from you is required.
• If your form has been "Declined" and you have received an email from DocuSign saying "Declined" in the subject line: You will be contacted by OHR to discuss the reason(s) as to why the form has been denied, along with details about what you may need to provide to complete your education benefit submission successfully.

Paperwork must be submitted once per academic year.

For Spouse

• Education Benefit Request Form for Spouse/Domestic Partner for the University of Pittsburgh (via DocuSign)
• Copy of your marriage certificate

For Domestic Partner

• Education Benefit Request Form for Spouse/Domestic Partner for the University of Pittsburgh (via DocuSign)
• Copy of your approved University of Pittsburgh Affidavit of Domestic Partnership

The education benefit will only be applied for the terms listed on the Education Benefit Request form for the University of Pittsburgh. If the student will be studying abroad or participating in a co-op program, please notify the Benefits Department to ensure the benefit processes on these tuition charges.

Submission of Required Documentation

To submit your request form and related documentation:

1. Access the Education Benefit Request Form for Spouse/Domestic Partner (via DocuSign).
   • Note: This form should be submitted only by the eligible retiree of the University of Pittsburgh (not the spouse/domestic partner).
   • This form and related documentation must be submitted once per academic year.
2. Enter your name and valid email on the form.
   • Note: Retirees do not need to use a Pitt email to submit the form.
3. After selecting "Begin Signing," you will be sent an access code to the email you entered. You must enter the access code you received to complete signing the form.
4. Enter all required information on the form, including attaching any related documentation.
   • For spouses: Attach a copy of the marriage certificate.
   • For domestic partners: Attach a copy of the University-approved Affidavit of Domestic Partnership.
5. Review your information. Once all information is entered and the form is signed, please select "Complete" from the DocuSign toolbar (at the top of the page).

Forms are processed by the Benefits Department within 1-2 business days. Please do not contact the Benefits Department about the status of your form unless it has been more than 3 (three) business days since you have submitted it for processing. After your form is processed, you will receive an email from DocuSign:

• If your form has been "Completed" and you have received an email from DocuSign saying "Completed" in the subject line: The benefit has been approved and will be processed. No further action from you is required.
• If your form has been "Declined" and you have received an email from DocuSign saying "Declined" in the subject line: You will be contacted by OHR to discuss the reason(s) as to why the form has been denied, along with details about what you may need to provide to complete your education benefit submission successfully.

Paperwork must be submitted once per academic year.

• Education Benefit Request Form for Dependent Children for the University of Pittsburgh (via DocuSign)
• Copy of the retiree's most recent Form 1040 U.S. Individual Income Tax Return, listing the student as a dependent son or daughter

Note: Individuals who request the dependent child(ren) education benefit for the 2022-23 academic year with their 2020 Form 1040 and 2021 Tax Extension will only have the fall term benefit applied at the time of the request. Once the 2021 Form 1040 is received, the remaining requested terms will be processed. If the 2021 Form 1040 is not submitted by the last business day of the fall term (December, 16, 2022) the benefit will be rescinded. A new benefit request form can be submitted for the spring and/or summer terms as long as they are received by the last business day of their respective term with the 2021 Form 1040.

The education benefit will only be applied for the terms listed on the Education Benefit Request form for the University of Pittsburgh. If the student will be studying abroad or participating in a co-op program, please notify the Benefits Department to ensure the benefit processes on these tuition charges.

Submission of Required Documentation

To submit your request form and related documentation:

1. Access the Education Benefit Request Form for Dependent Children (via DocuSign).
   • Note: This form should be submitted only by the eligible retiree of the University of Pittsburgh (not the dependent child).
   • This form and related documentation must be submitted once per academic year.
2. Enter your name and valid Pitt email on the form.
   • Note: Retirees do not need to use a Pitt email to submit the form.
3. After selecting "Begin Signing," you will be sent an access code to the email you entered. You must enter the access code you received to complete signing the form.
4. Enter all required information on the form, including attaching any related documentation.
   • Copy of the retiree's most recent Form 1040 U.S. Individual Income Tax Return, listing the student as a dependent.
5. Review your information. Once all information is entered and the form is signed, please select "Complete" from the DocuSign toolbar (at the top of the page).

Forms are processed by the Benefits Department within 1-2 business days. Please do not contact the Benefits Department about the status of your form unless it has been more than 3 (three) business days since you have submitted it for processing. After your form is processed, you will receive an email from DocuSign:

• If your form has been "Completed" and you have received an email from DocuSign saying "Completed" in the subject line: The benefit has been approved and will be processed. No further action from you is required.
• If your form has been "Declined" and you have received an email from DocuSign saying "Declined" in the subject line: You will be contacted by OHR to discuss the reason(s) as to why the form has been denied, along with details about what you may need to provide to complete your education benefit submission successfully.

Dependent children of retirees may be eligible to use this benefit at other institutions if you are currently utilizing the benefit (prior to retiring), or if the parent or guardian was employed full-time at the University for at least ten years immediately prior to retirement. Learn more about the education benefit for dependent children attending other institutions.