Course of Study Reimbursement Request

Course of Study Reimbursement Request
Board of Ordained Ministry

Cindy Muder, Course of Study Registrar

PO Box 207

Washington Mills, NY 13479
Full Name

First NameLast Name
Address for remittance of any reimbursement

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Name of Student's District
Please list course number(s):
Please attach course grades. You may use the COS Grade Sheet, if desired. A grade of "C" or better is needed for any reimbursement. Requests must be made the same calendar year as completion of the course took place.
- Once the Reimbursement Request and Grade Report have been received by the COS Registrar, a request for reimbursement of $75/course will be submitted to the UNY Conference Office.
- A check would then be mailed to the requestor from the UNY Conference.
Course Grade Report

Cancelof
Should be Empty: