Pre-Enrollment

Tuition assistance application

Complete the form below to request your referral for tuition assistance through HCTI. Have your employer information and 2–3 recent pay stubs ready.

Step 1

Your information

Program of interest *

First name *

Last name *

Email address *

Phone number *

Mailing address *

City *

State *

ZIP code *

Step 2

Employer information

Employer name *

Employer address *

Employer phone number *

Rate of pay *

Person of contact *

Step 3

Upload recent pay stubs

Upload 2–3 current check stubs from within the past 30 days to verify your 20+ work hours per week. Accepted formats: PDF, JPG, PNG. Max 3 files.

Click to upload pay stubsPDF, JPG, or PNG — up to 3 files

Step 4

Your responsibility & consent

I understand a $150 application fee is due now and counts toward my 50% tuition share.

I acknowledge that I must pay my 50% of tuition and meet all eligibility requirements.

I consent to HCTI making a referral on my behalf to the 3rd-party community agency.

I understand that I must reside in Jefferson County, Kentucky to qualify for tuition assistance.

I understand that to remain eligible for tuition assistance I must: maintain employment during the approved course, successfully complete the course, attend all required sessions with LUL, and provide all requested documentation by the required due dates. I understand that any missed appointment may result in denial of tuition assistance by LUL. I further understand that in the event tuition assistance is not approved, I remain responsible for all fees and costs associated with my enrollment in the course.

Step 5

Applicant signature

By typing your full legal name below, you acknowledge that this electronic signature is the legal equivalent of your handwritten signature and that all information provided in this pre-enrollment form is true and accurate to the best of your knowledge.

Type your full legal name (signature) *

Date signed *

Today's date is prefilled automatically when you open this form.

By submitting, you request to be referred for tuition assistance via HCTI. A $150 application fee is due now as part of your 50% tuition amount.