Tuition Reimbursement Initial Application

Tuition Reimbursement Initial Application

Applicant Information

Applicant Name*

Job Title*

CTE Program Name

Email Address*

Phone Number*

Phone

Mailing Street Address*

Address you would like the check sent to

Mailing City/State*

Mailing Zip/Postal Code*

Employer Information

District Name*

Select

Who is your Principal/Supervisor?*

If your supervisor's name is not on the list, please type it in.

Select or enter value

Principal/Supervisor's Email Address*

Who is your CTE Director/Administrator*

CTE Director/Administrator Email Address*

Why are you completing this course? (Satellite)*

Select

Why are you completing this course? (Central)*

Select

Tuition Reimbursement Coursework Plan*

I have met with my supervisor/principal to approve my Tuition Reimbursement Coursework plan that aligns with the courses for which I am seeking tuition reimbursement.

Course Information

Course Title for Certification Requirements*

You may select more than one course at a time not to exceed 4 credits.

Select

Intended AZ Constitution Start Date*

We require two weeks between receiving this application and the intended start date.

Intended AZ Constitution End Date*

Intended US Constitution Start Date*

Intended US Constitution End Date*

Intended Structure English Immersion Start Date*

Intended Structured English Immersion End Date*

Subject Knowledge Course Title*

Subject Knowledge Course Start Date*

Subject Knowledge Course End Date*

Course Title(s)*

Please separate course titles by commas. (Ex: Accounting 101, Accounting 102)

Course(s) Start Date(s)*

Please enter the dates in the order of course titles you listed above and separate each with a comma. (Ex: 8/20/24, 8/20/24, 10/13/24)

Course(s) End Date*

Please enter the dates in the order of course titles you listed above and separate each with a comma. (Ex: 10/10/24, 10/10/24, 12/8/24)

Course Number(s)*

Semester/Year*

Example: Spring 2025

Total Semester Hours*

Estimated Total Tuition cost ($)*

College/Institution*

Agreements

Registration and Start Date*

Upon entering into this agreement for reimbursement I agree to register for the class after I have been officially notified that a purchase order is in place and approved.

Completion Window *

Upon entering into this agreement for reimbursement I agree to complete my course(s) by the second Friday in June of this school year.

Reimbursement Application*

Upon entering into this agreement for reimbursement I agree to submit the reimbursement application within 20 days of completing the course.

Commitment to Remain Employed*

Upon entering into this agreement I agree to continue employment with the district at least two years after the date of receipt of funds or the reimbursement may need to be paid back to the district.

Reminbursement Unavailable

Unfortunately, tuition reimbursement is only available for CTE teachers who are currently employed by Pima JTED and our member districts.

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