Tuition Reimbursement Form - PDF by 2620


									                                LOS ANGELES UNIFIED SCHOOL DISTRICT
                                           CAREER LADDER
                                  TUITION REIMBURSEMENT REQUEST


1.   Reimbursement is made only for classes for which a grade of A, B, C, or credit is received.

2.   An On-Campus Advisement Form must be submitted if Cumulative GPA is below 2.75.

3.   Reimbursement is not made to those who have already received educational assistance from any
     other District program during the current school year.

4.   Reimbursement is made based on participant's Ladder Level with one exception: community college
     courses taken when a participant is at Ladder Level 3, 4, or 5 will be reimbursed at Level 2 amounts.

5.   Below are the deadlines for submission of tuition reimbursement requests and all paperwork:

            MONTHLY TERMS                   QUARTER/SEMESTER TERMS                   ALL PAPERWORK DUE

        September, October, November                         Fall                         March 31

         December, January, February                        Winter                         May 31

              March, April, May                             Spring                       September 30

               June, July, August                          Summer                        December 31

       *All requests must be submitted within 6 months of taking the class or test


1.   All information must be completed. Use a separate form for:
              each term for which reimbursement is requested
              courses from different colleges or universities

2.   Arrange for an OFFICIAL TRANSCRIPT to be sent from the college or university attended which
     includes the final grades for all courses for which reimbursement is requested. It is advisable to
     request a receipt from the college or university that indicates when the transcripts were ordered.
     Grade reports and unofficial transcripts are not acceptable. Unofficial transcripts will only be
     accepted if signed by Career Ladder On-Campus Advisers from CSUDH, CSULA, CSULB, and CSUN.

3.   Send the Tuition Reimbursement request form, advisement form and transcripts to:

                                                    Career Ladder Office
                                             Los Angeles Unified School District
                                            333 South Beaudry Avenue, 14th floor
                                                   Los Angeles, CA 90017

      For questions regarding tuition reimbursement, please call the Career Ladder Office at (213) 241-4571

              **Please allow 2 - 4 weeks for processing after all documents have been received**

                                              TUITION REIMBURSEMENT REQUEST
                                                    PLEASE PRINT OR TYPE
Last Name________________________________First____________                                                           Employee #:_____________

Address_________________________________________________                                                             LAUSD Email:
City & Zip Code:____________________________________________ Cell Phone:_______________
Work Site:________________________________ Work Phone:____________

SECTION II. WHEN AND WHERE COURSES WERE TAKEN (Use a separate form for each school and each term.)

College or University: ______________________________________________________________
                                                                                Transcripts: Attached                       Mailed Separately
Term:               Year:
                                                                                 Semester              Quarter

       Elementary                          Children’s Center Permit                                      Pupil Personnel Services

         Secondary                                                                                       Psychologist                          Counselor

      Special Ed.                                                                                Date B.A.
                                         Specialty (ie. MMD)                                                               Completed

 CBEST                CSET                 RICA             BCLAD
SECTION IV.            COURSES FOR WHICH REIMBURSEMENT IS REQUESTED                                                               OFFICE USE ONLY
      COURSE NAME                                                          COURSE #                  UNITS         GRADE
1.                                                                                                                           Approved           Disapproved

2.                                                                                                                           Approved           Disapproved

 3.                                                                                                                          Approved           Disapproved

4.                                                                                                                           Approved           Disapproved

The classes listed above are requirements for a bachelor’s degree and/or a teaching credential. I received a grade of C or better in each class. I understand that if,
within six months of receiving reimbursement, I terminate employment with the District, I must repay the amount of reimbursement. I also understand that, upon
completion of the Career Ladder, I must work as a teacher for the District for two years if offered a position or repay the amount of reimbursement received while a
participant in the program.

                                        Participant’s Signature                                                                         Date

                                                               FOR OFFICE USE ONLY
PA: 1     2 3 4          LADDER LEVEL ______

APPLICATION DATE:____________________                                          UNITS APPROVED                                  UNITS DISAPPROVED

Tuition Reimbursement Effective:                                Semester _____ Quarter_____                     ______    Transcript: Not Official / Not Submitted
                                                                                                                ______    Course(s) not on transcript
Winter          Spring          Summer            Fall           $_____________RATE
                                                                                                                ______    Grade below C
Hold for Advisement: _____Other Dist. Support____                $____________ REIMBURSEMENT                    ______    Received after deadline (___/___/___)
S / Q Units__________ GPA_________                                                                              ______    Non Credential Course (Level 5)
                                                                 Verified by ___________ Date _________         ______    Courses prior to effective date
Cert / Class
                                                                                                                ______    Receiving other District Support
Classcode                 Paycode                                Authorized by _________ Date _________
                                             -                                                                  ______    Hired as a teacher (date) ___/___/___
                                                                                                                                     Revised 06/08 SS

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