2004-07-28 WS & CC Meeting - Laserfiche WebLink

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. ( \ ... tervi[[e 'LstaEflsfiu! 11>57 City of Centerville Tuition Reimbursement Form Complete this section and receive approval prior to enrolling in this course. Employee Name: Job Title: Department: Class Name: *Attach course description 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: Yes No Date: Pre-Approval Signatures & Funding Source: City Administrator Signature: Date: Department Head Signature: Date: Account Coding: Reimbursement Request Section - Complete after class is finished. 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: Date: City Administrator Signature: Date: Department Head Signature: Date: 50