n n n n
n n
n n
Professional Staff
Request for Tuition Reimbursement
Submit this form to the Business Office, room SSC L143 or MS #10, no later than two weeks prior to the start of the class.This deadline assists in the equitable distribution of
professional development funds for all full-time and part-time bargaining unit members. It is the responsibility of the student to adhere to the deadline, which enables the
Business Office to effectively manage the distribution of Collective Bargaining Agreement funds.
PROFESSIONAL STAFF INFORMATION
First Name MI Last Name Date
Title
Division (select only one)
n
Academic Affairs
n
Administrative Affairs
n
Chief Executive Office
n
Continuing Education
n
Institutional Advancement
n
Student Affairs
COURSE INFORMATION
Semester (select only one)
n
Fall
n
Spring
Year
Educational Institution (Name)
COURSE TITLE NUMBER OF CREDITS
TOTAL NUMBER OF CREDITS
COST
Employee Signature
Amount of reimbursement
in accordance with CBA
Charge Per Credit $____________ X Number of Credits_____________ = Total Tuition $_______________
Total Cost $______________
Amount of $____________________
Please note: approval is dependent upon availability of funds.
REVIEW BY DEAN
Comments
Dean Signature Date
I have reviewed the above tuition reimbursement request and
nn
Approve
nn
Decline
REVIEW BY CEO
Comments
CEO Signature Date
I have reviewed the above tuition reimbursement request and
nn
Approve
nn
Decline
* Approved $____________________
*Approval is dependent upon availability of funds.
June 2020/PR
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