Fillable TUITION AID REQUEST Syracuse City Corporation Human Resources (Syracuse City)

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TUITION AID REQUEST Syracuse City Corporation Human Resources (Syracuse City)

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Syracuse City Corporation
Human Resources Department
Updated November 2020
1
Syracuse City Corporation
TUITION AID REQUEST
Date Request Submitted: ____________________
Tuition Aid Policy Information
Syracuse City offers tuition aid to full-time, non-probationary employees who wish to continue their education.
Tuition aid requests must be for courses of study that are related to the employee’s position with the City and
approval of tuition aid requests is subject to the availability of funds. Tuition aid request must be submitted for
approval prior to the start date of the course(s) for which the employee is requesting tuition aid. Approved tuition
aid requests will be paid to the requesting employee as provided in section 16.060 (c) of the Syracuse City
Personnel Policies and Procedures Manual. Employees who receive tuition aid will be required to return any aid
received if they terminate their employment with Syracuse City within one year after receipt of said tuition aid.
Employee Information
Name: _________________________________________________ Employee Number: _________________
Department: __________________________________ Job Title: ____________________________________
Date of Hire: _________________________________ Supervisor: ___________________________________
Course Information
Educational Institution: ________________________________________________________________________
Course Number(s): __________________________________________________________________________
Course Description(s): ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Estimated Tuition Expense*: ___________________________________________________________________
* Please attach a copy of any related receipts.
I hereby request approval for tuition aid as described above.
Employee Signature: ______________________________________________ Date: _____________________
Approval Details
Approved (please give the amount of aid approved): _______________________________________
Unapproved (please explain): _________________________________________________________
__________________________________________________________
Syracuse City Corporation
Human Resources Department
Form HR-114
Updated March 18, 2015
2
Approval Signatures
Supervisor: ______________________________________________________ Date: ____________________
Department Head: ________________________________________________ Date: ____________________
City Manager: ____________________________________________________ Date: ____________________
Tuition Aid Payment Information (to be completed upon employee’s completion of course(s))
1. Were the courses for which tuition aid was requested completed with a “C” grade or better? (a copy of the
employee’s transcript much be attached)
Yes (eligible for tuition aid payment)
Some (if more than one course taken; please specify which were completed): ___________________
_________________________________________________________________________________
No (not eligible for tuition aid payment)
2. If “Yes” above, please indicate which course(s) were completed with a “C” grade or better, the grade
received in each course, and the related percentage of aid that the employee is eligible for for each course
(refer to section 16.060 (c) for reimbursement percentage):
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
3. Please forward this completed form to the HR department for reimbursement.
FOR HR USE ONLY
1. Has the employee received any other tuition aid during the current fiscal year?
Yes – How much? $ ________________
No
2. Total amount of reimbursement for which the employee is eligible in the current fiscal year: $ ______________
3. Total amount of reimbursement for which the employee is eligible on this request: $ ______________
4. Total amount of reimbursement to be provided to the employee: $ _______________
5. Date the reimbursement was paid out to the employee: __________________________
6. Reimbursement processed by: _______________________________________________________________
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TUITION AID REQUEST Syracuse City Corporation Human Resources (Syracuse City)

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Completed 24 January 2021

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