Employee Reimbursement Request

Employee Reimbursement Request

Employee Information

Employee First Name*

Employee Last Name*

Employee ID Number*

Irving ISD Email Address*

Employee Phone Number*

Phone

Current Campus/Department*

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Current Position*

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Reimbursement Information

What type of reimbursement are you seeking?*

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When did this coursework, programming, and/or testing occur?*

Please note that you must be currently employed by the district during the semester in which you were attending school or completing certification programming/tests.

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Which critical teaching shortage area are you pursuing with your college coursework and/or certification programming?*

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College or Certification Program Name*

e.g. - IWU, Dallas College, Teachworthy, Region 10, etc.

Anticipated Date of Completion*

1.) If you are pursuing a college degree, list your anticipated graduation date.

2.) If pursuing teacher certification, list your anticipated certification completion date by which you plan to be fully certified to teach.

Total Amount Being Requested*

This amount should not reflect any monies received through other means of financial assistance (e.g., scholarships, grants, loans, etc.)

Acknowledgement of Eligibility Requirements*

I understand that, in order to qualify for Employee Reimbursement for the current school year, all eligibility requirements must be met.

Upload Reimbursement Documentation Here:*

The following documents are REQUIRED to support your request for reimbursement after completing college coursework or certification programming:

College Coursework Reimbursement Documentation for Paraprofessionals:

Unofficial Transcript (Note: funds will only be awarded for courses in which a passing grade was received), AND
Itemized Course Payment Confirmation or Receipt (Note: if you received financial assistance for the coursework, those funds will not be included in the total to be potentially reimbursed)

Future Irving Teachers (FIT) College Coursework Reimbursement Documentation for TCS and Interim Teaching Staff:

Unofficial Transcript (Note: funds will only be awarded for courses in which a passing grade was received), AND
Itemized Course Payment Confirmation or Receipt (Note: if you received financial assistance for the coursework, those funds will not be included in the total to be potentially reimbursed)

Future Irving Teachers (FIT) Certification Reimbursement Documentation for TCS, Interim, and LEAP Resident Teaching Staff:

Itemized Certification Program and/or Certification Test Payment Confirmation or Receipt (Note: if you received financial assistance, those funds will not be included in the total to be potentially reimbursed), AND
Documentation of successful completion of your assigned certification programming OR
Documentation of a passing score for a teacher certification test

Please be advised that all employees should review what type of information is required PRIOR TO submitting this form for review and approval. Failure to initially complete this form in its entirety can result in a denial of your request at this time. If you need further guidance on what specific information your required documentation should contain, please refer to this guidance document.

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Acknowledgment of Reimbursement Agreement*

I understand that, upon qualifying for Employee Reimbursement(s) for this current school year, and upon successful employment as a certified teacher with Irving ISD, I agree to remain employed in Irving ISD for the duration of the current school year (unless such employment is terminated earlier in the best interests of Irving ISD).

I also understand that failure to remain employed in Irving ISD for the duration of the school year can result in being responsible for repayment of expenses output by Irving ISD toward this course and/or certification reimbursement.

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