Tuition Reimbursement Application - Form A
SECTION I: Employee Information
Name
*
Date of Hire
*
/
Month
/
Day
Year
Date
Job Title
*
Scheduled Hrs/Wk
*
Location
*
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Elementary
Central Office
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City Primary
Section II: Academic Program Information
University
*
Location
*
Field of StudyMajor
*
Educational Goal
*
MA
MS
MBA
PhD
Other
Schedule while attending school hrs/wk
*
CompletionGraduation Date
*
/
Month
/
Day
Year
Date
Will you receive any grants, scholarships or benefits to support your tuition?
*
Yes
No
TUITION REIMBURSEMENT POLICY
Each employee shall obtain approval from the Lead Person to enrollment in any course for which enrollment is sought. Tuition assistance shall be provided only for GRADUATE COURSE(S) taken that are required for any license or certificate required for the employee's current position with
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Primary
Bronx Elementary
Central Office
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City
*
and also limited to the costs of tuition AT A DULY AUTHORIZED AND ACCREDITED INSTITUTION OF HIGHER EDUCATION, UP TO $3,000 PER YEAR.
ALL REIMBURSEMENT REQUESTS SHOULD BE SUBMITTED ON OR BEFORE JUNE 1st WITH THE OFFICIAL TRANSCRIPT FOR THE COURSES TAKEN FROM WITHIN THE FISCAL YEAR (i.e. JULY 1st, 2020 TO JUNE 30th 2021). THE TOTAL BUDGETED AMOUNT WILL BE SHARED EQUALLY BETWEEN ALL THE REQUESTORS AND WILL BE REIMBURSED BEFORE JUNE 30th.
** All summer courses will be counted in the next fiscal year.
Tuition reimbursement is available to staff/teachers AFTER COMPLETING THEIR FIRST YEAR OF FULL TIME EMPLOYMENT. Reimbursement of such costs SHALL BE PROVIDED UPON RECEIPT OF EVIDENCE of satisfactory completion of coursework with a grade equivalent to B or better; and prior to receipt of any tuition assistance, each employee shall be required to agree in writing to repay
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Primary
Bronx Elementary
Central Office
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City
*
the full amount of tuition assistance received in the event that he or she resigns or retires from
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Primary
Bronx Elementary
Central Office
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City
*
within one year of the date of receipt of the assistance.
I have read and accepted the policy above. I understand that my school can unilaterally rescind, modify, or make exceptions to any of these policies, or adopt new policies at any time with or without notice.
*
I understand and agree with the policy above.
Signature
*
Email
*
example@example.com
Signed On
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Please verify that you are human
*
Submit
Should be Empty: