Tuition Reimbursement Application

Tuition Reimbursement Application
Please review the Tuition Reimbursement Policy before submitting your application. If you can't view the policy below, please click the link below that is underlined "Tuition Reimbursement Policy".
Name*

First NameLast Name
Email*

Confirmation EmailYou will receive a confirmation to this email and status updates.
Location*
Current Position*
YesNo
You have to be employed as a full-time employee for 6 months with Serrato Corporation to apply for Tuition Reimbursement. You can continue submitting this form for communication purposes only.

By submitting this form, you are not submitting for Tuition Reimbursement.
Name of the School Attending*
Name of the Degree or Program*
UndergradauteGradauteCertificationOther
FallSpringSummer
YesNo
If no, please explain the reason why this application is being submitted after the class has started.
It is policy that applications are submitted before the class starts. Provide a reason why this application is being submitted after. Please note that the application may not be approved.
Class(es) Starts*

MonthDayYear
*Classes MUST be in the same school semester. Ex Spring, Summer, Fall. Use the date when first class starts.
Class(es) Ends*

MonthDayYear
Course Title 1*
Include Course Number if applicable
Add a Second Class?
Course Class 2*
Include course number if Applicable
Add a Third Class?
Course Class 3*
Include course number if applicable
Add a Fourth Class?
Course Class 4*
Include course number if applicable
How does the proposed course(s) relate to your job assignment/position and how will the course(s) provide knowledge and improve your performance?*
YesNo
If yes, please explain how your school schedule interferes with your work schedule. *
Total Costs of Classes/Tuition*
Total cost of classes and can add eligible expenses (e.g., required books/materials). Receipts are required; without a receipt, payment will not be processed.
Total Cost of Classes/Tuition
Total Cost of Books, Materials, or Other Eligible Expenses
LoanCredit Card/Check/Payment PlanFinancial Aid (Not a Loan)Grant/ScholarshipMilitary AssistanceOther
Please make sure all files are attached, by uploading the files below. *
Please attach an itemized statement of tuition and fees to this application.*

Cancelof
I understand that I have to be employed with Serrato Corporation for 6 months to be eligible to APPLY for Tuition Reimbursement.I have uploaded all required documents on the checklist or will make arrangements to submit additional documents upon receiving them. (Use the "Additional Comments" if a document is missing, any missing documents will not delay approval for application but WILL delay approval for payment).I understand that the max reimbursement I will receive is $5,000 per year (Jan-Dec).I understand that the receipt must be itemized; containing the costs for each class and not one lump sum of the classes.I understand that a receipt must contain the method of payment. Ex Loan, Credit Card, Cash, Payment Plan, Financial Aid etc.I understand my "School Schedule" must contain the Names of Classes, Semester, Dates, and Time.I understand that if I am submitting for additional expenses, I will upload the receipt for course materials.I will understand that I will not be eligible to receive reimbursement until after I complete my classes and receive a passing grade of "C" or better.I understand that I if my application is approved, it is my responsibility to remember to complete a "Check Request Form" for payment and submit along with my grades once I complete my classes within 30 days of the class end date, and if I miss the deadline I will not be considered for payment.I understand if my employment ends with Serrato Corporation during the semester, I will not be eligible for reimbursement.I understand that I must be a full-time employee with Serrato Corporation during the semester or I will not be eligible for reimbursement.
Additional Comments?
Employee Signature

Clear
Date Submitted*

MonthDayYear
Please wait until you see "Thank You" screen. This can take up to 1 min to fully submit.
Should be Empty: