<p> SOUTHERN COLUMBIA AREA EXCELLENCE AND PRIDE</p><p>GRADUATE COURSE APPROVAL/CREDIT REIMBURSEMENT REQUEST</p><p>NAME: ______DATE: ______ADDRESS: ______PHONE: ______PRESENT AREA OF ASSIGNMENT:______GRADUATE CREDITS COMPLETED TO DATE (including IU credits): ______GRADUATE LEVEL COURSE NAME: ______GRADUATE LEVEL COURSE NUMBER: ______COLLEGE OR UNIVERSITY: ______CREDITS TO BE EARNED: ______DATES OF REQUESTED COURSE: (Begin) ______(End)______BRIEF DESCRIPTION OF COURSE WORK: ______BASE TUITION EXCLUDING FEES (Attach proof of cost) $______</p><p>APPROVED: ______</p><p>REJECTED: ______</p><p>______Signature Superintendent’s Approval Date Approved</p><p>Upon completion of the graduate course(s), an official transcript must be provided to the District Office within 60 days following course(s) completion. Please note you must attain a grade of “A” or “B” (or equivalent in a non-graded course) to be eligible for tuition reimbursement. If you do not, any pre-reimbursement must be repaid to the district.</p><p>PRE-REIMBURSEMENT REQUESTED ( i f yes) </p><p>FOR DISTRICT OFFICE USE ONLY</p><p>Official Transcript Received: ______</p><p>Annual Allocation Amount: ______</p><p>Reimbursement Received This Academic Year: ______</p><p>Amount Requested: ______</p><p>Amount Approved: ______</p><p>Budget Account Code: 11240. ______</p><p>______Superintendent’s Approval For Payment QUALITY EDUCATION FOR EVERY CHILD gradcrse.frm (rev. 7/03)</p>