SCHOOL YEAR ______________
03/2020
(USE START DATE OF COURSE TO DETERMINE SCHOOL YEAR)
DELAWARE VALLEY SCHOOL DISTRICT
PRE-APPROVAL AND APPLICATION FOR REIMBURSEMENT FOR CREDITS
Undergraduate,
Graduate or
*In-service
*In-service credits are any credits taken in which you will NOT receive an OFFICIAL TRANSCRIPT through an accredited university (i.e. courses taken through an
Intermediate Unit, etc.).
Please refer to your current contract language for current reimbursement limits.
School years run July 1 – June 30
REIMBURSEMENT YEAR IS BASED ON THE START DATE OF COURSE
Superintendent’s Signature
For Credit Reimbursement:
(contingent upon balance of funds available)
COMPLETE THIS SECTION AFTER THE COURSE HAS BEEN COMPLETED FOR CREDIT REIMBURSEMENT:
1. Identify the appropriate cost of tuition below. This cost should be clearly identified on your invoice and should not include any
additional fees.
2. Attach copy of invoice. INVOICE MUST INCLUDE COURSE NAME AND INDIVIDUAL COST OF TUITION – account summaries,
payment confirmation and grouped charges will not be accepted.
3. Attach copy of an official grade report or transcript.
4. Are you eligible to receive reimbursement or scholarship in any amount through another plan or benefit for the educational
expenses incurred? Yes ____ No _____ If yes, please describe the amount reimbursable to you and the plan/benefit’s tax treatment
of the reimbursement made to you (i.e. taxed as income or provided tax-free): _______________________________________________________________
“DISTRICT OFFICE USE ONLY”
Business Administrator Signature
Actual cost of tuition
(Should not include materials, textbooks, online fees etc.)
