Tuition Reimbursement Tuition Reimbursement TO:Department Head DEPARTMENT: FROM: JOB TITLE: COURSE NAME: SCHOOL: LOCATION: COURSE DATES:Starting Month Day Year Ending Month Day Year ESTIMATED COSTS:Tuition Books TOTAL ESTIMATED COSTS: TOTAL REIMBURSABLE COSTS: This course will enhance my job performance or value to my department in the following way:I understand requests for reimbursement must be submitted within six months of course completion.Employee Signature:Date MM slash DD slash YYYY I have successfully completed the course described above, and have attached proof of that fact. Also attached are receipts for my tuition and books. Therefore, I am requesting reimbursement according to the benefit level I am eligible for.Actual CostsTuition Books TOTAL COSTS: REIMBURSABLE AMOUNTS:Tuition Books (See MOU for reimbursable amounts.) Total Costs Proof of Completion/Receiptsjpg, gif, png, pdf, mp4, avi, flv, wmv, mov, doc, docx, xlsx Drop files here or Select files Accepted file types: jpg, gif, png, pdf, mp4, avi, flv, wmv, mov, doc, docx, xlsx, Max. file size: 40 MB. I understand that I will be required to reimburse the City for a percentage of my reimbursement if I terminate employment of my own volition within 18 months of receiving tuition reimbursement as outlined in the Administrative Regulation No. 14 on Tuition Reimbursement.