First Name*

Last Name*

Phone *

Email *

Verify Email Confirm your email address.

MLH SAP/Personnel Number * Example: 123456

Verify MLH SAP/Personnel Number *

Division Location *

Highest Level of Education * Select the highest completed level.

Date of Birth*

Are you currently enrolled in college? *

Yes

No

Have you ever attended the University of Memphis? *

Yes

No

I verify that I am a full- and part-time Associate with Methodist Le Bonheur Healthcare (MLH) and have completed at least six months of continuous full- or part-time employment. *

Yes

No

My last MLH performance evaluation conducted by my leader was a Meets or Exceeds Expectations. *

Yes

No

I am not currently on a leave of absence (Family Medical Leave (FMLA) leave not included). *

Not currently on leave of absence (excluding FMLA)

Currently on leave of absence (excluding FMLA)

This will be my first bachelor’s degree. *

Yes

No

I have discussed my desire to attend UofM Global with my MLH leader/supervisor. *

Yes

No

I authorize the release of my MLH training and development records and current Tuition Assistance balance. *

Yes

No

To receive tuition assistance through this program we must share your educational records (including financial aid, grades, academic progress, etc) with your employer. The privacy of your educational records is normally protected under the Federal Educational Rights and Privacy Act (FERPA). Please review the FERPA guidelines and respond to the statement below. *

Family Educational Rights and Privacy Act (FERPA) website

I approve the release of my educational information to my employer and any third party directly related to my tuition benefits. I understand that this information is normally protected under FERPA guidelines, however I give my consent to share this information for the purpose of this program’s direct billing process. I also understand that if I do not give my consent, I will not be able to receive tuition assistance in this program.

Yes

No

University of Memphis/MLH Associate Advancement Program (MAAP) Student Agreement

I understand and agree that:

The tuition benefit is limited to undergraduate study at UofM Global in an approved major as determined by Methodist Le Bonheur Healthcare (MLH).
The tuition benefit applies to MLH employees and in accordance with MLH's eligibility standards.
Federal and/or state grants, and/or other financial awards will be applied to my balance prior to the tuition benefit offered by MLH.
To have my tuition paid by MLH I must fulfill each of the following conditions:
- Complete a current year Free Application for Federal Student Aid (FAFSA) and all additional procedures required by the Financial Aid office.
- Enroll, complete, and earn a final grade in online courses (M50s and R50s) only that meet the graduation requirements for my intended major.
- Commit to a fully online major in one of the approved areas.
- Assume responsibility for all fees and tuition for coursework in which my final grade does not meet graduation requirements. Disqualifying final grade may vary by course and may include: D, F, Withdrawal, Audit, and Incomplete.
- Notify a Student Advocate (maap@memphis.edu) that an eligible grade has been posted for an Incomplete, Missing Grade, and/or Grade Change after the semester of record within 60 days of the official posting of the grade change. The tuition benefit will be applied after the course work has been successfully completed in accordance with the academic policy of the institution in which I am enrolled, and I have fulfilled the other student agreement requirements for the semester of record in which I was enrolled, and I am employed at the time I request tuition payment.
- Assume responsibility for all fees and tuition if I terminate employment or if am dismissed for any reason by MLH or the academic institution.

I authorize:

the release of information about my grades, financial aid, academic progress and MLH employment record to my home institution
the release of information about my grades, financial aid, academic progress to MLH

As an MLH employee and college/university student, I

am accountable for all communication and program information.
will comply with all rules of the MAAP program and requirements of UofM Global.
will be bound by the University of Memphis' Code of Student Conduct.
will be disqualified from this agreement if I terminate employment, if I am dismissed for any reason by MLH or the institution in which I am enrolled during the semester of this agreement, or if I otherwise invalidate my eligibility.
understand that MLH and my home institution reserve the right to change terms, conditions, and benefits for the semester indicated below and thereafter.
understand that I may only participate in one MLH tuition benefit program in any given semester.

I acknowledge that I have read and agree to the student agreement.

I agree to receive text message communications from the University of Memphis. (optional)

Yes