Training & Reimbursement Request Form

Training & Reimbursement Request Form

This form is used to either request permission for an upcoming training event or to submit for reimbursement for an expense.
Select Training to request permission to attend upcoming learning initiatives and professional development. In addition to granting permission to attend, this approval may also act as a pre-approval for reimbursement.

Choose Reimbursement if you are seeking reimbursement for out-of-pocket expenses from the Department.

If you have questions before you fill out the form, reach out to QOLTraining@Phila.gov.
Type of Request:

Employee Information
Date

MonthDayYear
Name

First NameLast Name
Payroll Number
Job Title
Civil Service Title, if applicable
I am a...
Unit
Unit, if not listed
Phone Number
Format: (000) 000-0000.
Email
example@phila.gov
Reporting Location
Reporting Location, if not listed above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Email
Unit Manager Email
Supervisor Email
example@example.com
Unit Manager Email
example@example.com
If your supervisor's or manager's email address is not listed, please contact sarah.adamo@phila.gov to have it added.
Training Email
example@example.com
Budget Email
example@example.com

Reimbursement Request
If you submitted a Training Request via JotForm and received an approval, provide the Training Request Form Number:
This number can be found in the confirmation email
Type of Reimbursement

Other
Upload your Certificate of Completion, Professional Organization Membership, or UCC Registration Card

Cancelof
Upload proof of payment associated with training/course

Cancelof
Should be Empty:

Employee Information