TUITION REIMBURSEMENT EVIDENCE UPLOAD FORM

 

 
First Name

Last Name

 
 

 
Home Address

 

 

 

City

Zip Code

 

 

Email Address

 

 

Building  

Position

 

Tuition Reimbursement Evidence

(Please complete additional electronic forms if requesting more than one course) 

 

College/University

 

Title of Course

 

Number of Graduate Credit Hours

 

(Hour Type)

 

 

Term/Date of Course

 

Tuition Reimbursement Evidence Documents

(please upload each file separately)

  • Payment receipt for course

  • Course grade card

 

   

 

 

Click SUBMIT  only after you have finished uploading your evidence document to the Tuition Reimbursement Committee.

You will receive an email confirmation once the committee has received this evidence form.

You may PRINT  a copy of the next page for your records.

 

Thank You for Using the Electronic Tuition Reimbursement Evidence Form!