Tuition Reimbursement Form - Memorial Health System printable pdf download

Tuition Reimbursement Form - Memorial Health System

Tuition Reimbursement Program

EMPLOYEE REQUEST FOR TUITION REIMBURSEMENT GUIDELINES

Use the following checklist to keep track of each step in the reimbursement request process.

Step One: Getting Approval

The employee must complete SECTION I and forward the request forms to his/her Supervisor/Manager for

completion of SECTION II prior to attending class(es).

If Supervisor/Manager approves, he/she forwards the request to the respective System Leader

Representative for final approval. If approved, the System Leader signs the application and returns it to the

employee. If not approved, Manager records the reason in the additional comments section on the

application, discusses reasoning with employee and sends all paperwork to the Workforce Development

Department.

Step Two: Submitting Approved Application

After the Supervisor/Manager and System Leader Representative have both signed the application form, it

is returned to the employee who forwards the completed form to the Workforce Development Department

prior to attending class(es).

Workforce Development Department Contact Information: Fax Number: 217-527-3089, Attn: Elle

Gronewold

E-Mail Address:

Step Three: After Completing Coursework

After successful completion of coursework, the employee is to submit final grade(s), tuition bill, and

receipts for textbook purchases to the Workforce Development Department within one (1) month of

class completion. The student must contact Workforce Development if there are extenuating

circumstances that prevent the student from obtaining grades within one (1) month of course

completion.

The Workforce Development Department will verify final grade(s) and costs, evaluate the number of hours

worked in the previous 12 months to determine reimbursement eligibility, and complete SECTION III

before submitting forms to the Accounting Department for reimbursement.

Depending on current

legislation, an employee’s reimbursement may be subject to taxation.

Tuition Reimbursement Form - Memorial Health System