Education Assistance Program Application

FIELD HOURLY TUITION REIMBURSEMENT ASSISTANCE APPLICATION  Must work and maintain 25 hours per week to participate in the Tuition Assistance Reimbursement Program.  Must be employed by the company six months prior to course completion, one year of service required for Graduate studies.  Submit signed application, itemized receipt of tuition expenses and corresponding grades, within 60 days of the course completion date, to Team Member Services via fax number 972.307.6069  You are responsible for the initial payment of tuition and ensure all documents are received by Team Member Services within 60 days of course completion.

Name Employee ID: Telephone/Email: Location: Course Dates: Name of School:  Beginning ______Degree:  Ending ______Program: □ Graduate □ Undergraduate □ High School □ Vocational □ Other

Course# Course Name Course# Course Name

Student Signature Date: For Team Member Services Use Only – Do Not Write Below Date of Hire: Final Course # Grade Tuition Cost Year of Participation______Reimbursement Amount 1. Previous Reimbursement 2. Previous Reimbursement 3. Previous Reimbursement 4. Current Reimbursement 5. Pay Period End Date 6. Reimbursement Approved by

Approved □ Denied □ Average hours/week______Reason for Denial______

4/6/2018