Version 2-15
ETSU Request for Tuition Reimbursement
Name: ___________________________________ Employee ID #:__________________
Department: ______________________________ Job Title: ____________________________ Index#: __________
Date of Employment: __________ % of Employment: ______ Office phone: ______________ Cell/home phone: ______________
Alternate work schedule requested: [ ] Yes [ ] No If yes, attach schedule
Tuition Reimbursement Program up to 6 additional credit hours per term
Institution: ____________________________ Term: ____________________
Course #
Title
Hours/CEUs
Class period (days/time) (Ex: T TH 9-10)
RODP (Yes/No)
Employee’s current degree status: _______________________ Degree/Area: ___________________________
This course of study enhances the employee’s value to the home institution as defined below (check one):
( ) Support for the pursuit of a terminal degree
( ) Support for an employee pursuing a non-terminal degree in a professional or technical area
( ) Support for an employee training or retraining to enhance expertise needed by the institution
( ) Other (explain):_____________________________________________________________________________________
Total reimbursement requested: ___________ Reimbursement may not exceed eligible fees for a maximum of 6 credit hours per term.
An employee may enroll in more than one course during the summer, as long as the summer terms in which the classes are to be taken
do not overlap.
By requesting support for tuition reimbursement, I agree with the stipulations listed in a-f below:
a. The recipient, unless retired, shall be required after the completion of course(s) to be employed by the institution for not less
than one month of employment for each month of the term of participation in the reimbursement program.
b. Satisfactory completion of coursework must be demonstrated to receive reimbursement and to remain eligible for continued
participation in the reimbursement program. Institutions may provide reimbursement at the time fees are due.
c. Courses should be scheduled in counsel with supervisors to assure maintenance of optimum job performance. Courses should
be scheduled at times other than during regularly scheduled work hours unless use of leave or other arrangements have been
approved by the supervisor prior to enrolling in the course.
d. I will notify Student Financial Aid Services of this financial assistance.
e. If attending a TBR or UT system institution the Application for Fee Waiver MUST be used first. I have used the fee waiver
for one class this semester.
f. I hereby authorize ETSU to review my student record to determine satisfactory completion of my coursework.
I have read and fully understand the requirements (as detailed in the appropriate section of TBR Guideline P-130) related to my
above-stated request for educational assistance, including stipulations related to future use of the program, proof of satisfactory course
completion, provision of receipts for reimbursement requests, and stipulations related to payback provisions.
I hereby authorize ETSU to make payroll deduction for any deduction for any advance payment of educational fees and tuition made
to me if I fail to submit a receipt to Human Resources documenting the payment of educational fees and tuition, or if the course
identified on the request form is dropped prior to the start of classes or if payback provisions of this agreement are not met.
Applicant’s signature: ____________________________________________________________ Date: _______________________
I approve the above request and have addressed scheduling issues related to the employee’s attendance in the classes detailed above.
Supervisor’s signature: ___________________________________________________________ Date: _______________________
Business Office Approval: ________________________________________________________ Date: _______________________
$_____________________________scholarships for ________________Term $________________ reimbursable amount
I attest that the employee meets the program requirements for the above-stated request.
Office of Human Resources: _______________________________________________________ Date: _____________________
Version 2-15
Faculty or Administrative/Professional Staff Tuition or Maintenance Fee Reimbursement Program
(PERTAINS ONLY TO CREDIT COURSES TAKEN AT ANY PUBLIC OR PRIVATE INSTITUTION OF HIGHER LEARNING)
A. This program's general goal is to encourage faculty and staff members to develop their skills and knowledge through participation in educational
programs and is intended to serve as a means of job-related career development.
B. The program is designed to provide assistance for an employee who takes credit courses in a degree program while continuing work responsibilities.
C. The program should be used in the employee's pursuit of a degree that is judged by the employer in its sole discretion to be beneficial to the institution.
1. Eligibility
a. Any regular part-time or full-time employee who has been continuously employed by the institution for at least six months, may,
upon verification of service, be eligible to participate.
1) Regular part-time employees may receive a pro rata portion of assistance based on percentage of employment.
2) Employees with prior temporary service immediately preceding regular employment shall receive credit for such service
if they qualify for leave accrual and longevity adjustments.
b. TBR employees who retire with at least 10 years of state service maintain eligibility under this program.
2. Fees Paid/Type Course Paid/Number of Hours
a. This program is designed to provide maintenance or tuition-related fees for a maximum of six (6) credit hours per term, as term is
defined by the employing institution, with a maximum of four (4) terms per year.
b. An employee may enroll in more than one course during the summer as long as the summer terms in which the courses are to be
taken do not overlap. Tuition-related fees may include maintenance fees, registration fees, tuition, debt service fees, technology
access fees, online course fees, RODP fees, service charges and incidental fees payable at the time of registration.
c. Employees are responsible for required deposits, special course fees, books and supplies, application fees, applied music fees, lab
fees, off-campus facility fees, parking fees, traffic fines and similar fees.
d. Employees must meet the requirements for admission and the regular academic rules and regulations of the institution offering the
course.
3. Payback Provisions
a. Unless retired, the recipient shall be required, after completion of the course or courses, to be employed for not less than one (1)
month of full-time employment for each month of the term of participation in the Tuition Reimbursement Program.
1) Early voluntary separation will, therefore require the employee to reimburse the institution for the remaining balance of
this commitment.
b. In order to receive future reimbursement, participants must satisfactorily complete all course requirements as defined by the
academic program in which they enrolled. A grade of Incomplete at the conclusion of the grading period or a withdrawal is not
considered as satisfactory completion. The employee must pay for and satisfactorily complete the same number of hours before
again being eligible for this program. Exceptions will be made only in cases (1) where a course is failed for health reasons or (2)
where another substantial reason is recognized by the attending institution's academic guidelines.
4. For employees taking courses at other than the home institution, reimbursement applications shall be conditionally approved and held by the
office designated by the institution to process these requests until the employee requests reimbursement and documents satisfactory course
completion. At that time, the employee will be reimbursed for the prior course(s) and subsequent applications may be conditionally
approved.
5. At the institution's discretion, fees may be waived for classes taken at the home institution, but employees will be subject to the provisions of
this guideline regarding service time after the class and satisfactory course completion. Successful completion of courses must be
documented before being granted approval to take subsequent classes under this program.
6. When the Participant May Attend
a. Courses should be scheduled at times other than during the regularly scheduled work hours unless the use of annual leave or an
adjusted work schedule has been documented and approved by the supervisor prior to enrolling in the program.
7. Accounting/Budget Provisions
a. Requests for approval to participate in the Reimbursement Program shall be submitted via the Request for Tuition Reimbursement
form.
1) If the employee is required to pay fees when due, fees may be paid in accordance with the provisions of Deferred
Payment Plan Guideline B-070, provided a Deferred Payment Plan has been implemented at the institution the
employee is attending.
b. The employer institution shall account for the chargeback as an employee benefit to indicate the employer institution is paying the
cost for the benefit of the employee. The charged institution shall remit the tuition fees to the institution providing instruction as
maintenance income.
8. Limits on Tuition Reimbursement Rates
a. Requests for participants attending public institutions will be reimbursed at the current semester hour rate for that institution.
b. For individuals who wish to attend other than a Tennessee public institution under this program, reimbursement will not exceed
the highest current semester hour rate for a comparable program offered by a Tennessee public institution.
c. Reimbursement for concentrated programs at public or private institutions will be limited to the prevailing graduate fee rate for
a comparable program within a Tennessee public institution.
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