The School District of Philadelphia s1

THE SCHOOL DISTRICT OF PHILADELPHIA CAREER DEVELOPMENT FUND PROGRAM CRITERIA FOR TUITION REIMBURSEMENT

1. Appointed Secretary, School Operations Officer, Paraprofessional, Non-Teaching Assistant, and the Professional-Technical Unit.

2. Approved Long Term Substitute for period of approved long-term status. (No summer unless there is previous approval, i.e., secretary.)

3. Must take college level courses at an accredited college or university. Video or correspondence courses will not be approved for reimbursement.

4. Must secure grades for college credit (“C” or above or “Pass” with qualifying statement of average or course status) as evidence of successful completion.

5. Collegiate grants or approved stipends granted by the collegiate institution will be deducted.

6. All courses must be related to the field of education or educational support fields.

7. Fees incurred for advanced credits granted by a university are not reimbursable. The program reimburses only for actual courses taken and completed during the academic time of Spring 2013 though Fall 2013 with a passing grade of “C” or better.

8. No payment is made for a transcript evaluation, books, and other fees charged by the university.

9. Practicum or field experience must be taken outside of applicant’s regular working hours unless on approved leave of absence or sabbatical leave. THE SCHOOL DISTRICT OF PHILADELPHIA

APPLICATION FOR TUITION REIMBURSEMENT Spring 2013 though Fall 2013

Employee Name:______EIDN: ______

Home Address: ______Home Telephone: ______

______Work Location Name: ______City Work Location Number: ______State Zip Work Telephone: ______

****************************************************************************************** Job Classification, Check One:

Secretary ___ Paraprofessional ___ NTA ___ Prof-Technical ___ School Operations Officer ___ Other ___

Eligibility: Tuition reimbursement is provided for secretaries, school operation officers, paraprofessionals, non-teaching assistants, and staff from the professional-technical bargaining unit in the Agreement between The School District of Philadelphia and the Philadelphia Federation of Teachers, Local 3, American Federation of Teachers AFL-CIO. (Sec.XIII.H.1-4)Reimbursement is not given for tuition covered by grants received from another program. ****************************************************************************************** Current Enrollment: List all completed courses. Check one: Associate Degree ____ Undergraduate ____

Course Title and 2013 Semester Tuition Per Number Name of College University Spring Summer Fall Credit Hour Total Credits

Amount of Tuition Reimbursement Requested $ ______

Amount of Grants Received from Other Sources $ ______

Matriculated Student: Yes______No ______

I hereby acknowledge that the information listed above is accurate.

Date:______Applicants Signature______****************************************************************************************** For Office Use Only

____ Approved ____ Disapproved Total ______

Reviewed by ______Signature ______Date ______THE SCHOOL DISTRICT OF PHILADELPHIA Authorization to Release Financial Aid Information

PART II MUST BE COMPLETED BY THE COLLEGE/UNIVERSITY EVEN IF YOU DID NOT RECEIVE FINANCIAL AID

PART I.

TO: Financial Aid Office of ______(Name of College/University)

I hereby give you permission to release information to The School District of Philadelphia regarding financial aid that I have received, or am receiving, to be included with my application for tuition reimbursement for the period of 1/01/13 through 12/31/13. This certification is necessary whether you have or have not receive any financial aid and must be signed by the college or university official in order to have your application processed.

______Last Name First Name Maiden Job Title

______Address School/Office

______City State Zip School/Office Phone Home Phone

______Employee Identification Number (EIDN) Students Signature ************************************************************************************************** PART II.

TO: The College/University – Please complete this portion and return to Ms. Deborah Schultz, The School District of Philadelphia, Education Center, 440 North Broad Street, (Portal D) Suite 222, Philadelphia, PA 19130.

The above-named student did ______did not ______receive financial aid.

Spring 2013 Summer 2013 Fall 2013

GRANTS: Pell Grant ______

PHEAA ______

SEOG ______

TOTAL GRANTS ______

LOANS: Guaranteed Student Loan ______

National Direct Student ______

College University ______Phone No:______

Signature______Title ______Date ______