Fillable Virginia Community College System Educational Assistance Request Form (Southwest Virginia Community College)

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Virginia Community College System Educational Assistance Request Form (Southwest Virginia Community College)

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The Virginia Community College System Educational Assistance Request Form (Southwest Virginia Community College) form is 1 page long and contains:

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  • 10 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Southwest Virginia Community College

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VCCS-16 Revised 11/2010
Virginia Community College System
Educational Assistance Request Form
Employee Name
Original
Appointment Date
College/System Office
Social Security Number
Empl ID (ID used SIS login)#
Position Title
Section/Division
Teaching Field
(For Faculty)
After Hours Study
During Hours Study: Note: for classified employees an adjusted work schedule will be attached.
Leave of Absence With Pay: Promissory Note Must be Completed
Leave of Absence Without Pay: If educational expenses are being paid, promissory note must be completed.
College/University to be attended ________________________________________________
College Address______________________________________________________________
Time study will be pursued _____________________________________________________
Course Title
Semester
Hours*
Start
Date
End
Date
Tuition
Costs
Mandatory
Fees
*Limit of 6 credit hours per semester
Sub Total
Grand Total All Costs
Purpose of Assistance (Check One)
Job-Related: Supervisor’s signature verifies that course is related to current position responsibilities
Degree Requirement: Verification of acceptance into a degree program must be on file
Non-job related (after hours classes)
Payment Option (Check One) Note that IRS Tax regulations apply
Reimbursement: Contingent on receipt of a grade of “C” or better and supporting documentation.
Up-Front Payment: Promissory Note must be completed and attached to this form.
Waiver under the Continuous Learning Program (Educational Assistance Policy)
_________________
Date of Aid Request
__________________________ _________________ ____________________________________________
Employee Signature President’s Approval or Designee
___________________________________________
Supervisor’s Approval
0
0
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Virginia Community College System Educational Assistance Request Form (Southwest Virginia Community College)

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Completed 27 July 2020

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