PROPOSAL FOR TUITION REIMBURSEMENT
Name:_________________________________________________________________________ Date: ____________________
Department/Division:_____________________________________________________________________________________________
Accredited four year Institution:_____________________________________________________________________________________
Address:_______________________________________________________________________________________________________
City: _____________________________________________________ State: _________________________ Zip: __________________
Phone Number: _______________________________________________
Course Name:___________________________________________________________________________________________________
Course Number:_________________________________________________________________________________________________
Term or Date of Enrollment: _____________________________________
Total Credit Hours: ____________________________________________
Improvement anticipated:
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
_________ Reimbursement will be requested.
_________ Advancement on the salary schedule will be requested.(Faculty Only)
The Tuition Reimbursement Policy is intended to reimburse actual tuition expenses that the employee has incurred up to the designated per
credit hour rate at an accredited four year institution. Prior approval by the appropriate supervisor and the Director of Human Resources is
required and must be obtained before taking the desired coursework. Complete Part 1 and 2 of this form and follow Steps One through Four
of the Tuition Reimbursement Policy Procedures (found on back).
I am requesting reimbursement for actual tuition expenses that I have paid in the amount of $ ___________________________.
Please list all forms and dollar amounts, if any, of financial assistance:
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Signature of Employee ___________________________________________________________________________________________
I, _____________________________________________________________________________________, hereby certify that the above
class does not interfere with the normal contractual hours of the employee listed above.
________________ ________________ ___________________________________________________________________
Approved Denied Supervisor Date
________________ ________________ ___________________________________________________________________
Approved Denied Director Human Resources Date
Tuition Reimbursment Policy
Full-time employees may request consideration for remuneration of tuition expenses at an accredited four-year institution. Expenses will be figured per semester credit hour and reimbursed up
to a maximum rate as established in Procedures. Prior approval by the respective supervisor and the Director, Human Resources, and evidence of successful completion are required. Tuition
reimbursement forms must be completed prior to the beginning of the class and are available in the Human Resources office.
Effective July 1, 1982, College reimbursement will not be granted for additional training or credits earned which qualifies the faculty member for a new assignment or position.
No reimbursement will be provided for credit or training which is obtained at College expense or which conflicts with a day of service, as defined by Board Policy 4013.
Full-time faculty members who meet the requirements for salary range advancement will be granted a salary increase subject to deduction or repayment, whichever applies, at the current
educational reimbursement rate, for any college reimbursement received since October 1, 1979, and thereafter. The form Application for Salary Range Advancement, available in the Human Resources
office, must be filed prior to March 15 of the ensuing school year when salary range advancement is expected. See also Board Policy #4051.
Procedure
The maximum credit hour tuition reimbursement is $200.00 per semester credit hour effective January 1, 2015.
White - Human Resources Copy Yellow - Employee’s Copy
December 2014
