Fill and Sign the Assistance Request Form

Tuition Assistance Request SECTION I: EMPLOYEE Employee Name:       ID#:       Job Title:       Division/Section/Group:       Extension:       Employment Status: Regular, Full Time Regular, Part Time Hours Per Week       Name of College/ University: Type of Course: Graduate: Undergraduate: Course # Course Title (Include Credit Hours and Total Tuition and Fees)                                                 Will this course work apply to a degree program? Yes No If yes, have you submitted an Approval for Degree Program form? Yes No Type of Degree:       Major Field:       Total Hours Required:       Hours Completed:       (If the coursework does not apply to a degree program, describe the job-related reason for enrolling in the course in a memo signed by your supervisor and attached to this form.) Signature of Employee:_______________________________ Date:       ADVANCE AMOUNT REQUESTED FOR TUITION AND FEES:       (Book fees are reimbursed after an itemized receipt is submitted to the Training and Development Department). SECTION II GROUP LEADER AUTHORIZATION Check one: This coursework maintains or improves skills required in the employee’s current position. Yes No This coursework will qualify the employee for a new trade or business , or is needed to meet the minimum education requirements of the employee’s current position. Yes No Supervisor/Group Leader Signature: ____________________________________ Date:       SECTION III: TRAINING AND DEVELOPMENT DEPARTMENT TUITION ADVANCE: Date:       Amount: $       Payable to:       BOOKES REIMBURSED: Date:       Amount: $       Payable to:       Advance Approved: ___________________________________ Taxable: Yes No Date:       Training and Development Manager Record of Grades:       Close Out Approval: