Stamford Education Association 

Request for Tuition Reimbursement Funds


Please review the guidelines here.

Last five digits from paystub

Per Article 20F of the contract, I hereby apply for tuition reimbursement for the graduate course(s) listed below.  These credits were granted by an accredited college 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)

Note: Limited to Nine (9) credits per fiscal year (Summer, Fall & Spring Semesters)

Class Begin Date *
Class End Date*
$
Do you have another class to submit? *
Class Begin Date (2)*
Class End Date (2)*
$
Do you have a third class to submit?
Class Begin Date (3)*
Class End Date (3)*
$
Check the box that applies: *

Description Area

Proof of Grades
No File Chosen
File uploads may not work on some mobile devices.
Proof of Payment
No File Chosen
File uploads may not work on some mobile devices.
Do you have any additional documents you need to upload?
Additional Supporting Documents
No File Chosen
File uploads may not work on some mobile devices.
Additional Supporting Documents
No File Chosen
File uploads may not work on some mobile devices.
Use your mouse or finger to draw your signature above
Today's Date
:  

Human Resource Department

$
ie. date to expect check by...
Date Approved
Today's Date
:  
Powered by Formstack Create your own form