3.460 RCUH Tuition Expense Reimbursement Policy
Research Corporation
of the University of Hawai‘i
Human Resources Department
Page | 1 of 2
RCUH Tuition Reimbursement Application Form
Instructions: Complete this form and attach a copy of your Course Registration/Receipt. Your complete application must be
turned in to the RCUH Human Resources Department NO LATER THAN the close of business 2 days prior to the first day of
instruction of classes in the applicable semester.
PLEASE SUBMIT COMPLETED APPLICATION TO:
RCUH_ADMIN@RCUH.COM
SECTION 1
Employee Name:
Employee Number:
Phone Number:
E-mail Addres
s:
Job Title:
Project:
Principal Investigator(s):
SECTION 2
University of Hawaii Campus: Manoa Maui Hilo Other*:
*If attending a course of instruction outside of the Universi
ty of Hawaii system, please attach the current tuition and fee schedule
for your school, a current course description, and justification that it is a course not similarly offered at a UH campus.
Course Semester: Fall Spring Summer Course Start Date: Estimated Completion Date:
Course Number/Name: Course Level: Undergraduate Graduate
Course Description: Please describe the course and its relevance to your position at RCUH (Attach additional page if necessary.)
Credits Requested (max 3 credits per semester): Cost per Credit: $
Total Tuition Reimbursement Requested: $ Receipt/Confirmation of Course Registration Attached
SECTION 3
Applicant Certification of Awareness (Please initial next to each item as acknowledgement):
I am not receiving any other type of educational assistance through the GI Bill, scholarships, or other tuition
reimbursements.
I am not on a disciplinary or leave status.
RCUH will reimburse up to the cost of three (3) credits per academic semester or nine (9) credits per calendar
year and the rate will be limited to the cost per credit for Hawaii residents at UH Manoa.
I will submit my final grade report to the Director of Human Resources within thirty (30) days of course
completion with a grade of “C” or
better.
This program may be modified or terminated at the discretion of the RCUH Board of Directors.
I have read the R
CUH policy pertaining to the Tuition Reimbursement Program (3.460) and agree to abide by the requirements
as stated. I understand that I am responsible for my own tuition bills regardless of the amount of assistance provided by the
RCUH.
Applicant Signature Effective
July 1, 1997 (rev. 06/2020)
Date
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