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EDUCATION REIMBURSEMENT REQUEST <br />Prior to registering for course/degree program—Required for each course) <br />Name: Department: <br />Full-time Employee Regular Part-time employee <br />Course or Degree Program: <br />College/University: <br />Estimated Cost(tuition, lab fees, direct costs) <br />Supervisor Approval: Date: <br />Personnel Committee Approval: Date: <br />Complete for reimbursement upon completion of course) <br />Course (if in a degree program): <br />Date: Budgeted: <br />Reimbursement Requested: <br />tuition,lab fees and direct costs—books,student union or association fees,qualifying tests,mileage <br />and parking fees not reimbursed) <br />Grade: Undergraduate "B"or "70"or above required, <br />Graduate `B" or"80" or above is required.) <br />In courses which do not issue grades,certification of satisfactory completion is required.) <br />Supervisor Approval: Date: <br />Finance Department and Human Resource Use Only) <br />Account Code: Amount: <br />Accounts Payable Employee File Employee Department Copy