PROCEDURE:
1. EMPLOYEE: completes form, attaches required documents, and submits form to the Department Director.
2. DEPARTMENT DIRECTOR: reviews, makes a recommendation, and submits form to the HR Department.
3. HR DEPARTMENT: reviews for completion, fund availability, and forwards form to City Manager’s Office.
4. CITY MANAGER: reviews, makes a decision, sends original to HR Department, and copy to the employee.
Name:_______________________________________________ Date Employed:________________________
Position:_____________________________________________ Department:___________________________
Name of College or University:________________________________________________________________________
Degree Plan Sought: ________________________________________________________________________________
Semester/Year Course(s) to Commence: ________________________________________________________________
Please state how the degree sough meets the objectives of the Tuition Reimbursement Program:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
A copy of degree plan must be attached to this request
Are you eligible for or will you be receiving any other financial assistance for your education? Yes / No
Employees receiving tuition assistance from a source that does not require repayment (Veteran’s benefits, grants,
scholarships, etc.) are required to submit reimbursement requests for the balance of the tuition covered by the
alternate source.
The City of Stephenville has the right to audit the employee’s educational and financial records that may be contained in
the employee’s records at the institution attended. Any right that the employee may have pursuant to the Family
Education Rights and Privacy Act of 1974, or any similar act, are waived by acceptance of tuition reimbursement. By
signing this application, I acknowledge that I am familiar with the requirements for tuition reimbursement pursuant to
the City’s Personnel Policy and agree to abide by those requirements.
Employee Signature:___________________________________ Date:__________________________________
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DEPARTMENT DIRECTOR ACTION
Recommend reimbursement Do not recommend this application for tuition
Department Director Signature: _________________________________ Date: ___________________________
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CITY MANAGEMENT ACTION
Approved Disapproved
City Manager Signature:____________________________________________
APPLICATION FOR DEGREE PLAN APPROVAL
Step 1: Tuition Reimbursement
Form 6
