Tuition Assistance Program (TAP)

For information related to the Tuition Assistance Program, please review all policies and procedures at www.atlfrf.org/tap.

Today's Date *

Date

Applicant's Name *

Prefix First Name Middle Name Last Name Suffix

AFRD Email *

example@example.com

Preferred Mobile Number *

Area Code Phone Number

Are you a new or returning TAP applicant? (Select returning if you have received TAP reimbursement at least once since 2016) *

If you selected returning, how much have you received this calendar year?

Rank *

Station/Location *

Shift

What deadline are you applying for? *

What degree type are you currently pursuing? *

What is your program of study? (Ex: Fire Science, Public Administration, Homeland Security) *

Are you currently in good standing? (As defined by the Office of Professional Standards) *

Yes No Don't Know

What is the name of your college/university? *

What is the accrediting body for your college/university? (Your college/university must be regionally accredited to apply for this program) For information, visit https://www.chea.org/regional-accrediting-organizations *

Accrediting Commission for Community and Junior Colleges (ACCJC) Western Association of Schools and Colleges Higher Learning Commission (HLC) Middles States Commission on Higher Education (MSCHE) New England Commission of Higher Education (NECHE) Northwest Commission on Colleges and Universities (NWCCU) Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) WASC Senior College and University Commission (WSCUC)

Please list the name(s) of the classes you are requesting reimbursement. *

What is your current GPA? *

What is your overall GPA? *

What is the total tuition cost you are requesting reimbursement for? *

Have you received grants or scholarships to cover tuition expenses for this semester? (Examples, include, Pell grant, HOPE scholarship, institution discounts) *

Yes No

If yes, how much did you receive?

Are you or have you requested tuition reimbursement in any form from another source other than the Atlanta Fire Rescue Foundation, Inc.? *

Yes No

Preferred Delivery of Tuition Reimbursement

Pick up from Public Safety Headquarters Pick up from Atlanta Fire Rescue Foundation office Mail to my home address

Home Address (Required if you selected home address from options above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Transcript (Must reflect classes, current and overall GPA) *

Browse Files

Itemized Invoice (Must reflect amount paid for tuition costs) *

Browse Files

I certify that I am an employee of the Atlanta Fire Rescue Department and that information entered on this form is true and accurate. I certify that I am not receiving reimbursement funds from another source for the semester/term requested in this application. I am requesting reimbursement for my personal funds expended for college tuition from the Atlanta Fire Rescue Foundation. I acknowledge that it is my responsibility to submit complete, accurate, and timely documentation as requested by the committee.

I do hereby acknowledge and agree to maintain employment with the City of Atlanta for a period of no less than 24 months following the reimbursement of any tuition fees by the Atlanta Fire Rescue Foundation. If I resign, retire or separate from the employment of the Atlanta Fire Rescue Department within 24 months of reimbursement, I must reimburse the Atlanta Fire Rescue Foundation the full amount of the reimbursement within in 90 days of my separation date. I understand that any unpaid balance after 90 days will be turned over to a collection agency.

I certify that I have read and understand the statements provided above. Electronic signature (Use mouse to sign form electronically when using computer) *

Clear