The University of Tennessee
2015 Professional Privilege Tax Benefit Application
* All fields are required
Indicate your eligibility by reviewing and checking these items. (Checked = Yes, Unchecked = No)
I am a full-time employee of the University of Tennessee.
My license is directly related to my duties as a UT employee.
I am NOT employed as a graduate assistant, intern or medical resident.
Should I leave state employment, I will notify the Department of Revenue immediately,
and I will again be responsible for any subsequent payment of the Professional Privilege Tax.
Provide a brief explanation of how your license is related to your duties as a UT employee:
UT Personnel Number
Full Legal Name
Telephone (including area code)
Agriculture - Experiment Station
Agriculture - UT Extension
Agriculture - Veterinary Medicine
Health Science Center - Clinical Educ Center - Chattanooga
Health Science Center - Clinical Educ Center - Knoxville
Health Science Center - College of Medicine
Health Science Center - Family Practice-Jackson
Health Science Center - Family Practice-Memphis
Health Science Center - Family Practice-Knoxville
Health Science Center -Other Units
IPS-CIS, LEIC, Central Office
UT Foundation, Inc.
UT System Administration
Please re-enter Email Address
PLEASE REVIEW ALL FIELDS FOR ACCURACY BEFORE SUBMITTING DATA
Deadline for applications is Friday, May 08, 2015 at 11:59:00 PM
System Budget and Finance · 711 Andy Holt Tower · The University of Tennessee
Knoxville TN 37996-0174 · 865.974.2243 · fax: 865.974.1324