2004-12-20 CC Packet - Laserfiche WebLink

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City of Centerville Tuition Reimbursement Form Complete th,is section and receive apprQval prior to enrolling in thi~ course. Employee Name: Job TItle: Department Class Name: *AtIach course descrIptJon Class Dates: to How does this class relate to your job? Estimated Tuition Cost $ Name of School: Address of School: Are you working toward a degree? If yes, list degree Employee Signature: Pre-Approval Signatures & Funding Source: City Administrator Signature: Department Head Signature: Account Coding: Reimbursement Request SectIon - Complete after class is finished. Yes No Date: Date: Date: Date Class Completed: Final Grade: * *Attach copy of grade sheet - Employee must receive a passing grade (C or eqUivalent) In order to receive reimbursement Actual Tuition Cost * Attach receipt for tuition Employee Signature: City Administrator Signature: Department Head Signature: Date: Date: Date: After the Reimbursement Request has been approved, send to the Finance Department with the original receipt and an expense report. Send a photocopy of completed Tuition Reimbursement Form to the City Administrator for Inclusion in your personnel file. 51