Tuition Reimbursement Form - Memorial Health System (Page 3 of 3) in pdf

Tuition Reimbursement Program

TUITION REIMBURSEMENT – SECTION II (Supervisor/Manager)

Funding for the education of our employees is based upon the needs of the organization as well as the

employee’s educational goals. Employees will be awarded tuition reimbursement based on the

employee’s present job skill needs or to prepare the employee for future advancement within Memorial

Health System. The tuition reimbursement process requires employees to receive prior approval from

their managers for the coursework. If, after discussion and the review of employee file, you believe the

employee meets eligibility requirements, and the coursework is appropriate as indicated above, you

should complete this evaluation form and forward to your System Leadership Team Representative for

final approval. Following System Leadership Team Representative approval, please return all forms to

the employee who will forward all completed forms to the Workforce Development Department. These

forms must be completed and submitted prior to the employee attending class(es).

Employee Name:

Does the chosen coursework support the present and future business needs of Memorial Health

System? If yes, please explain what business need(s):

__________________________________________________________________________

What did the employee receive on his/her most recent performance appraisal?

_______________

Does the employee have a record of behavior that supports Memorial’s Behavioral Standards and

policies? (If employee has active corrective actions on file, mark “No”.)?  Yes  No

Do you recommend the employee for Tuition Reimbursement?  Yes  No

Additional Comments:

___________________________________________________________________________

Manager/Supervisor: Please sign this form and forward to System Leadership Team

Representative for approval.

Manager/Supervisor Signature

Date

System Leadership Team Representative Signature

Date

TUITION REIMBURSEMENT – SECTION III (Organization Development Division Use Only)

Student’s final grade(s):

;

Total hours worked in last 12 months:______________________

Total amount to be reimbursed: ___________________________

Tuition Reimbursement Form - Memorial Health System Page 3