Publix Tuition Reimbursement: Individual Course Reimbursement Request Form
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1Tuition Reimbursement: Individual Course Reimbursement Request
Instruction
Tuition reimbursement department
If you have Tuition Reimbursement Program questions, visit
For a class to be considered for reimbursement, send the following to the Tuition
> Career and Self Development > Tuition
Reimbursement department within 45 days of class completion:
Reimbursement Program or contact us.
• a completed copy of this form
Email:
• a copy of your grade report and
Phone:
(863) 688-7407 ext. 55999
Fax:
(863) 284-3325
• an itemized receipt (showing a breakdown of your tuition cost for your class
Address:
Publix Super Markets, Inc.
and the method/s of payment).
Human Resources/Tuition Reimbursement Program
P.O. Box 407
Once your request is processed, you’ll receive an email at the address you
Lakeland, FL 33802-0407
provided in PASSport and from your immediate supervisor/manager. If you do not
receive an email within four weeks, please contact us.
When contacting us, please provide your Publix personnel
number (located on your pay statement).
Note: If your course is part of a degree program, complete the Undergraduate Reimbursement Request (associate’s or bachelor’s degree) or the
Graduate Reimbursement Request (master’s degree).
Associate information
Name
Personnel number
Personal email address
Verify your email address in
PASSport.
Job title
Store number or support department name
School and course information
School you attended
Course #
Course Title
Start Date
End Date
Credit Hours
Grade
Payment information – from your attached receipt(s)
Reimbursement criteria: To be eligible to receive reimbursement, you must
Total Tuition Cost
$
•
be a current and approved Tuition Reimbursement Individual Course
participant on the date that your classes ended
Methods of Payment
Amount of Payment
•
participate in an approved area of study at a regionally accredited school
•
be an active associate with at least six months of consecutive service since
Grants and/or Scholarships*
$
your last hire date
•
maintain a minimum average of 10 work hours per week based on a 52-
Loans and/or Prepaid Tuition
$
week average or entire employment if employed less than one year
Cash, Check, Money Order and/or
•
maintain a minimum Total Performance Rating of Meets Expectations on
$
Credit Card
your performance evaluation
•
*Tuition expenses paid for with grants or scholarships will not be
receive a grade of “C” or better in the class and
•
reimbursed.
be an active Publix associate on the date funds are disbursed.
Note: The entire amount of your tuition reimbursement is subject to income taxes. Federal and state income tax withholding (if applicable) and
Social Security and Medicare taxes (FICA taxes) will be deducted from your tuition reimbursement funds. Federal income tax will be withheld at a
25% supplemental income tax withholding rate. The gross amount of your tuition reimbursement funds will be included in Box 1 of your Form W-2.
Updated: 08/21/2014
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