TUITION REIMBURSEMENT
NAME
First Name
Last Name
Email
example@example.com
INSTITUTION
LIST COURSES TAKEN (INCLUDE FINAL GRADE):
DATE COURSE(S) COMPLETED
-
Month
-
Day
Year
Date
AMOUNT OF REIMBURSEMENT ($100 PER COURSE)
Signature
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ATTACH A COPY OF TRANSCRIPT OR REPORT CARD TO VERIFY COURSE COMPLETION
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SYSTEM APPROVAL STATUS
Please Select
APPROVED
DENIED
ASSISTANT SUPERINTENDENT
First Name
Last Name
Signature
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Should be Empty: