Rev: 8/15/19
HUMAN RESOURCES DEPARTMENT
CLASSIFIED ENROLLMENT FEE REIMBURSEMENT FORM
Name: _______________________________ A# ___________________________
Course Requested: _______________________ Semester: _____________________
Enrollment Fees Paid: $ __________
I hereby certify that I have not received funding for enrollment fees from any other
source. I certify that I have reviewed and understand section 17.11.2 of the CSEA CBA
and that eligibility for reimbursement is contingent upon compliance with 17.11.2.
_____________________________ ____________________________
Employee Signature Date
Approved
________________
Denied
_____________________
_____
Supervising
Administrator
Date
Approved
________________
Denied
__________________________
Supervising Administrator
Date
Approved
________________
Denied
__________________________
Superintendent/President
Date
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