Non-Union Employee
Education Reimbursement Application
Page 1 of 2 rev 08/22/2018
Education reimbursement applications are accepted, reviewed and approved in accordance with
the Education Reimbursement Policy for Non-Union Employees. Reimbursement limit is
$2,000/employee per fiscal year (July 1-June 30). Applications are accepted on a rolling basis
throughout the fiscal year, and approved in the order received, until appropriated funding is
exhausted. Please submit applications to the Personnel Office at City Hall.
Employee Name:____________________________ Department: ______________________
Educational Institution: __________________________________________________________
Course Title: ___________________________________________________________________
Course Description: _____________________________________________________________
______________________________________________________________________________
Course Start Date: _____________________ Course End Date: _____________________
Reimbursement Amount Requested: ________________________________________________
Statement of how coursework will assist employee’s professional development, job performance,
and career path within the City of Somerville: ________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employee Signature:____________________________________ Date:__________________
Department Head: ____________________________ Date: _________________________
Personnel Director: ___________________________ Date: _________________________
Accepted Denied - Rationale: ________________________________________
Completed by Employee
Authorization Signatures
