· Certified Professional Development Request Form - cindy - web-based

Tuition Reimbursement

Name

First Name

Last Name

Email

Today's Date

MM

DD

YYYY

Position

Department

Name of Educational Institution

Program Degree

Course Title(s) and # of Course Credits for Each

Tuition

Reimbursement will not be made until grade card and receipts are provided.

$

Date Course Completed

MM

DD

YYYY

Grade(s) Earned

I understand that if I leave employment with HWCEC, either voluntarily or involuntarily, for any reason, within one year after reimbursement, I will reimburse HWCEC for any amounts reimbursed and/or advanced in the year prior to my separation. In this regard, I specifically authorize HWCEC to withhold from wages or other amounts due me after separation of employment any amounts to repay this debt. If such withholding is insufficient to cover the repayment debt I will make other arrangements to pay the remainder owed.

Tuition Advancement

This form is to be completed and returned to Human Resources prior to the start of course.

Name

First Name

Last Name

Email

Today's Date

MM

DD

YYYY

Position

Department

Name of Educational Institution

Program Degree

Course Title(s) and # of Course Credits for Each

Course descriptions need to be available upon request.

I wish to advance 80% of the tuition costs for the above course(s) in the amount of

$

I understand that I must provide a copy of full tuition payment from the college within 5 business days. I further understand that if I do not complete the course, withdraw from the course, or make a grade of D or lower, I agree to reimburse HWCEC. In this regard, I authorize HWCEC to withhold from wages or other amounts due me to repay the advancement. If such withholding is insufficient to cover the repayment of the advancement, I will make other arrangements to pay the remainder owed.

I understand that if I leave employment with HWCEC, either voluntarily or involuntarily, for any reason, within one year after reimbursement, I will reimburse HWCEC for any amounts reimbursed and/or advanced in the year prior to my separation. In this regard, I specifically authorize HWCEC to withhold from wages or other amounts due me after separation of employment any amounts to repay this debt. If such withholding is insufficient to cover the repayment debt I will make other arrangements to pay the remainder owed.

TRAINING + EDUCATION

Tuition Reimbursement

Tuition Advancement

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