TOWN OF LOS GATOS
TUITION REIMBURSEMENT REQUEST FORM
POLICY: The Town will reimburse T.E.A., Confidential, Management, and POA employees 100% of the cost of
books, university/school fees (except parking) and tuition up to the maximum reimbursable rate.
1) The reimbursement shall be only for courses that are directly related to the employee’s position as determined
by the Town Manager, including general education courses that are generally related to attainment of a job-
related degree or certification. General education courses not generally related to the employee’s position will
not be eligible for reimbursement. Reimbursement shall be taxed pursuant to State and Federal regulations.
Total reimbursements that exceed $5,250 in a calendar year will be taxed and reimbursed through payroll.
2) Application for
tuition reimbursement shall be made to the Town before the course begins. Prior to
reimbursement of costs, all course work must be completed with a passing grade of “C” or equivalent when
numerical score or pass/fail is given.
3) Any employee who terminates employment with the Town within one year from the completion of a class or
classes, for which tuition reimbursement was paid shall refund all tuition paid under this provision, unless
required to attend by the appointing authority.
PRE-APPROVAL
For Fiscal Year:
T.E.A., Confidential, Management - $1,500
P.O.A.: equivalent to 2 semesters at the
San Jose State University full-time rate
Middle Initial:
Check one: Degree Program Certificate Program Non-Degree Program
Employment Status: Full-Time Part-Time
$/Cost
to
Total cost:
Total to be reimbursed:
FINAL APPROVAL
Submit a copy of the pre-approved request with proof of class completion and final passing grade.
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