SAU Prior Approval & Reimbursement Form

Stamford Administrative Unit

Prior Approval for Tuition Reimbursement

Please review guidelines here.

Choose Semester *

Administrator Name

Employee ID#

Thursday Location *

Job Title*

Administrator City Email *

Per Article 11 of the contract, I hereby apply for prior approval for tuition reimbursement for the course(s) listed below. I understand that available tuition will be allocated among all interested administrators who meet the deadlines.

Course Number*

Course Title

University/College*

Course Start Date*

Course End Date *

# of Credits *

Teacher Total Tuition Cost * $

for this semester

Description Area

Employee Signature *

[clear]

Use your mouse or finger to draw your signature above

Today's Date *

HR Approval

Human Resources Prior Approval

Approval*

Amount Allocated per Administrator $

Denial Explanation

Processed by...

Today's Date

SAU Request for Tuition Reimbursement

Stamford Administrative Unit

Request for Tuition Reimbursement Funds

Per Article 11 of the contract, I hereby apply for tuition reimbursement for the course(s) listed above. These credits were granted by an accredited college and/or university. Please include the following attachments to the Human Resources Department via the upload links below:

Proof of Grades - print out from college/university website

Proof of Payment - copy of canceled check, credit card receipt, evidence of student loan or print out from college/university website

(Your request will not be processed until proof of grades and payment are received- if you can't attach, please fax concurrently to (203) 977-4325 or email to BOE.HRGenInfo@StamfordCT.Gov)

Proof of Grades

No File Chosen

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Proof of Payment

No File Chosen

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Do you have any additional documents you need to upload?

Yes No

Additional supporting documents

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Additional supporting documents

No File Chosen

File uploads may not work on some mobile devices.

Signature

[clear]

Use your mouse or finger to draw your signature above

Date/Time

Human Resources Funds Approval

Funds Approval *

Approved Denied - Did not follow guidelines

Reimbursement Funds Denial Explanation

Total Approved Tuition Reimbursement Funds* $

Approved by...*

Notes for email... *

Date/Time