Tuition Reimbursement Application

Tuition Reimbursement Application

The Hendrick Health Employee Tuition Reimbursement Program provides tuition reimbursement to current full-time Hendrick Health employees for education obtained to certify the employee to work in a critical need position at Hendrick Health.

Employees must have graduated, completed certification exams, obtained their license or certification and be working in a full-time position with Hendrick Health prior to applying for tuition reimbursement. Some positions require employment in that capacity for at least 6-mos prior to applying. Please speak with your current Supervisor before applying.

***The initial process for tuition reimbursement could take up to 60-business days.

If you have any questions, please email Scott Foster at sgfoster@hendrickhealth.org

First Name*

Last Name*

Lawson Number*

Address*

City*

State*

Zip*

Email*

Phone Number*

Phone

Other Degree if not listed above

If your degree was not listed in the above dropdown box, please indicate it here.

School Name*

From which educational institution did you receive your degree or certification?

School's Location - City, State*

Total Student Loan Debt or Payments Made*

Total dollar amount of student loan debt from all creditors or if Self-Pay, the total dollar amount paid.

* Proof of debt or proof of payment is required in order to receive reimbursement.

Attach Proof of Debt Here (Must Include Your Name)*

Drag and drop files here or

Name of First Creditor or Self-Pay*

Total Amount of First Loan. If Self-Pay, put N/A*

Name of Second Creditor

Total Amount of Second Loan

Name of Third Creditor

Total Amount of Third Loan

Repayment Period*

* Tuition Reimbursement will be applied to the first or second paycheck of every month. Because Tuition Reimbursement is considered income per IRS regulations, the applicant will be taxed on the amount of the monthly reimbursement. If an applicant chooses to be reimbursed over the four year period, the applicant will receive the total amount of reimbursement in the shortest amount of time and will pay more in taxes each month. If an applicant chooses to be reimbursed over eight years, the applicant will receive the total amount of reimbursement over the longest amount of time and will pay less in taxes each month.

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Have you received Hendrick tuition assistance?*

Have You Previously Received Any Tuition Assistance from Hendrick Health through our Pay as You Go or Career Journey Programs or have You Received Tuition Reimbursement for Any Degrees You Earned?

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A form will be sent to you through DocuSign to submit your signature, your direct supervisor's signature, and your department director's signature electronically.*

I hereby acknowledge that the Hendrick Health Tuition Reimbursement program in no way alters the employment at-will relationship. I acknowledge that, in order to stay eligible for the Tuition Reimbursement program, I must maintain full-time employment (36 hours per week). If at any time my status is no longer full-time or if my employment with Hendrick Health is terminated, I will no longer be eligible for tuition reimbursement.

To begin receiving tuition reimbursement, I must submit all required documentation. Documentation includes: Tuition Reimbursement Application, the Tuition Reimbursement Agreement, proof of licensure, authorization to verify education, and proof of debt.

This agreement requires the applicant’s signature, direct supervisor’s signature, and the nurse manager’s signature. All of these signatures will be obtained electronically through DocuSign.

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Department Name*

Direct Supervisor's Name*

Department Director's Name*

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