Educational Assistance Pay as You Go Program

Educational Assistance

Pay as You Go Program

Please complete the form below if you are interested in the Hendrick Health Educational Assistance program for current employees.

Are You Accepted & Enrolled in the Program of Study at Your Chosen School?*

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First Name*

Last Name*

Are You 18 Years of Age or Older?*

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Are You a Current Hendrick Employee? (Pool, Part-Time, or Full-Time)*

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Lawson #*

Date of Hire*

Department*

Director/ Manager Name*

School Attending*

Are You an International Student?*

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Tuition cost (From Current Tuition Statement)*

Additional Fees (Books)*

Degree/Certification Pursuing*

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Would you have gone to school?*

If Hendrick did not provide tuition assistance, would you have gone to school to pursue this degree or certification?

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Would you have remained employed with Hendrick?*

If Hendrick did not provide tuition assistance for this degree/certification, did you plan to remain employed at Hendrick?

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Program Start Date*

Projected Graduation Date*

Best Email Address to Contact You*

Cell Phone Number*

Tuition Statement for Current Semester (REQUIRED)*

***This needs to be the personalized and itemized tuition statement you get after you've enrolled in classes, not an estimation sheet.

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