Agenda - Council - 11/13/2018 - Laserfiche WebLink

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Pre Approval for Tuition Reimbursement To be eligible for reimbursement of 50% of tuition, books and lab fees, employees must complete and submit this form for approval of the Department Head, Human Resources Manager and City Administrator before registering for a Bachelor's degree or a class. Eligible classes must be job -related and a benefit to the City or they must be part of a degree program which has been approved by the City Administrator. Satisfactory completion (receipt of C or better or a passing grade) of the course is required for reimbursement. When a "Request for Expense Reimbursement" form is submitted, a receipt for payment of tuition and lab fees, grade transcript, and copy of the completed pre - approval form must be attached. Reimbursements are on a first come, first served basis and shall not exceed the department budget. Please complete this form and give it to your department head who will forward it to the other reviewers. • The original will be placed in your personnel file and a copy will be returned to you. Employee name: y p De artme t: t Gogr/5 gm) / t /cam Employee number: Clads /' ate. gq ..� ' S' Cost.of Tuition per Credit (minus all fees): Estimated Colt of Books: School name: H"Y9-Gt4 Lim L' C' Course dates: Position: / �� Number of credit hours: 42/f a School address (1): 7- to / Z- School address (2): To be completed by the HR Manager: This employee has been approved by the City Administrator f r enrollment in a job -related post -secondary educational program. =�`c1z-cf ,//-7 /'- Yes, approval date _ No How is this class related to your job? 41,2_5e ce417, 76 w2G/�'i/c /� ,-01"5-S1---- How will your taking this class benefit the City? My signature below indicates that I understand the terms of the Tuition Reimbursement Policy, including the following provision: In the event an employee leaves the City, any reimbursement for education received during the 12 monthsto lea u ust be returned to te City by the employee. Employee Signature Date ******************************************************************************* Request has been: Department Head's Signature Human Resources Manager's Signature City Administrator's Signature Approved Date Date Date Denied Date Date Date