Step 2 Tuition Assistance Request Submission Form

Tuition Assistance Request Submission Form

This form is for submission of your education assistance requests. You must be pre-approved to use this form. The Employee Tuition Reimbursement Program provides reimbursement of tuition for classes at any accredited higher educational institution. This program provides reimbursement of tuition up to $2,000 per fiscal year for regular, benefit eligible employees. Questions: learninginstitute@cctexas.com, 361.826.3336
Personal Information Page
Type of Submission*
Employee Name*

First NameLast Name
Employee ID*
Employee Email Address*
example@cctexas.com
Employee Phone Number*
Please enter a valid phone number.
Hire Date*

MonthDayYear
Date
Department*
Supervisors Name*

Course Information Page
School Name*
Course Name*
Course Number*
Course Start*

MonthDayYear
Date
Course End*

MonthDayYear
Date
Estimated Cost*
Degree Type*

GED/High School DiplomaAssociates DegreeBachelor's DegreeMaster's DegreeDoctoral DegreeOther
How will this course benefit you and the City of Corpus Christi?*

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Upload Your Proof of Course Information

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Your Reimbursement Form and Supporting Documents

Merge all your documents into one - if possible.
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I understand that if reimbursement for this course or program is approved that, upon presentation of adequate proof of successful course or program completion, I will be paid as qualified for the cost of eligible items.

I also understand that this refund is subject to all applicable payroll withholding requirements.

I understand that I must apply for reimbursement within forty- five (45) days of receipt of my grades for the course or program.

I understand that if I am receiving financial assistance for education or technical training under a federal or state grant/entitlement or scholarship the reimbursement by the City, when added to the other benefits received, will be limited to a total of 100% of eligible expenses.

If I am receiving any such assistance I will submit along with my reimbursement request, paperwork detailing the assistance I am receiving to ensure my reimbursement does not exceed 100% of eligible expenses.

I understand that failure to provide this information could constitute business fraud and result in disciplinary action up to and be including termination.

Further, I understand that if I leave the City within 1 year after completion of the course or program that I will be required to repay funds provided by the City on my behalf, as outlined in the procedure.

I authorize this deduction to come from my final paycheck, or if there are insufficient funds in my final paycheck, I agree to provide cash or money order for the balance of the total amount. By signing below, I certify that I have received, read, understand, and agree with the criteria outlined above.
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Tuition Assistance Request Submission Form

Personal Information Page

Course Information Page

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