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Get City Of Richmond Tuition Assistance Application Form

City of Richmond Human Resources Department TUITION ASSISTANCE APPLICATION Important Notice Please read the Tuition Assistance Policy. After completion send entire form to your Appointing Authority or designee. APPLICATION FOR Check one Date Social Security No. Present Address Street Apt. City of Richmond Human Resources Department TUITION ASSISTANCE APPLICATION Important Notice Please read the Tuition Assistance Policy. After completion send entire form to your Appointing Authority or designee. APPLICATION FOR Check one Date Social Security No* Present Address Street Apt. No* City Department Job Title Fall Winter EMPLOYEE DATA Spring Summer Year Name Zip Code Bureau/Division Home Phone Work Phone Date of Employment COURSE INFORMATION Name of School Address List course s for which you are requesting assistance. Attach verification of payment Course Credit Course Title Start Date End Date Number Hours Cost per Credit Total Tuition Explain how course s is are related to your work or to your field of endeavor. Be specific Type of Program Undergraduate Graduate Richmond Technical Center Major or Certificate Sought Will you receive Financial Assistance from another source for the course s for which you are requesting Tuition Assistance No If yes please list type of assistance Amount Yes In accordance with the Virginia Privacy Protection Act the information requested will be used to determine your eligibility for Tuition Assistance. I hereby apply for reimbursement in accordance with the established Tuition Assistance Policy and the requirements of the Department of Human Resources. I have read the policy and I understand and agree to comply with its provision* I also certify that the information above is correct. Signature of Applicant Date DEPARTMENT RECOMMENDATION I have reviewed this application and recommend its approval* Signature of Department Director or Designee Application for Tuition Assistance has been approved for reimbursement. Reason Department Coordinator Date FOR DEPARTMENTAL USE ONLY Invoice Number Date Application received Date Verification received Final Grade s Payment Approved Date Received Denied HR Form No* 26 Amount of Reimbursement. After completion send entire form to your Appointing Authority or designee. APPLICATION FOR Check one Date Social Security No* Present Address Street Apt. No* City Department Job Title Fall Winter EMPLOYEE DATA Spring Summer Year Name Zip Code Bureau/Division Home Phone Work Phone Date of Employment COURSE INFORMATION Name of School Address List course s for which you are requesting assistance. No* City Department Job Title Fall Winter EMPLOYEE DATA Spring Summer Year Name Zip Code Bureau/Division Home Phone Work Phone Date of Employment COURSE INFORMATION Name of School Address List course s for which you are requesting assistance. Attach verification of payment Course Credit Course Title Start Date End Date Number Hours Cost per Credit Total Tuition Explain how course s is are related to your work or to your field of endeavor.

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