<p>Tehachapi Valley Healthcare District</p><p>POLICY: ACADEMIC ASSISTANCE POLICY NUMBER: 300.92 Original/Rewrite 03/11/2011 ORIGINATING DEPT: HUMAN RESOUCES APPLIES TO DEPTS: ALL</p><p>PURPOSE</p><p>To provide the opportunity for TVHD employees to improve job performance and become more eligible for promotion by taking courses outside the workday; thus improving quality of care, improving employee satisfaction, retention and reducing recruiting/orientation related expenses. </p><p>POLICY</p><p>TVHD will assist employees who meet established eligibility criteria in acquisition of certain skills by means of those program mechanisms described hereafter. It is the policy of TVHD to encourage employees to enroll in outside courses depending on operating budgets. The District supports partial or full reimbursement for courses and other related fees to enable the employee to accomplish future goals when economically feasible to do so.  The employee must be working a full-time schedule for at least 12 months before requesting any academic assistance from TVHD.  Education must relate clearly to the employee's current position at TVHD, or to a pre-determined internal transfer or promotion. This issue will be decided by the Department Head and Human Resources Director in consultation with Administration as necessary.  No one with below average performance evaluations or documented “verbal or written" warnings within the last 12 months will be considered for academic assistance.  Employees may not receive assistance from TVHD for a course or within a program for which further academic assistance is being received or is available (for example, G.I. Bill benefits)  Employees must maintain at least a 2.0 grade point average or equivalent to qualify for reimbursement.  The maximum reimbursement will be $3,000 per calendar year not to exceed 100% of covered expenses. Tuition, books, and required labs will be covered. Purchase or repair of a computer or printer used to access courses or complete course work is not covered expenses. Academic institution and program must be approved in advance on the Academic Assistance Request Form.  Courses qualifying for reimbursement must be completed in an accredited, recognized educational institution. College or university courses, business college and high school evening courses are qualified under this program. Seminars and requests for CEU credits are not eligible for reimbursement under this program.  The employee will be required to sign an agreement to the effect that up to $3,000 of reimbursement is forgiven for each 2 years of employment post graduation, and that resignation or discharge for cause prior to having all reimbursements forgiven will necessitate repayment to TVHD of the remainder (see attached agreement).</p><p> If an employee terminates within one year of receiving academic assistance, TVHD shall require full or partial reimbursement, per signed agreement (see attached agreement).</p><p>Examples:</p><p>Any employee who aspires to become CNA, LVN, RN (ASN, BSN, MSN), PA or NP is eligible for reimbursement of related expenses as previously defined if he/she meets previously stated criteria. Academic assistance is not limited to clinical areas or careers.</p><p>PROCEDURE</p><p>Employees must complete the appropriate application and receive approval from their Department Director/Supervisor and Human Resources and complete the appropriate forms prior to requesting reimbursement. </p><p>Human Resources will forward the approved Academic Assistance Application and any accompanying documentation to the Hospital Administrator/CEO for approval. Human Resources will inform the employee of approval/denial and, if approved, will keep the approved form awaiting completion of class(es) if applicable.</p><p>Once the class(es) are completed, employees must provide receipts and grade report to Human Resources when requesting reimbursement.</p><p>Human Resources forwards the completed and approved application with receipts and a check request to Accounts Payable for processing.</p><p>Human Resources tracks the amount of reimbursement per calendar year per employee and the employee’s commitment to Tehachapi Valley Healthcare District should employment be terminated and reimbursement from the employee be sought. APPLICATION FOR ACADEMIC ASSISTANCE</p><p>THIS SECTION TO BE COMPLETED PRIOR TO ENROLLMENT IN COURSE</p><p>Employee’s Name: </p><p>Address: </p><p>City: State: </p><p>Zip Code: </p><p>Department: </p><p>Current Position: </p><p>Hire Date: ______</p><p>Title of course or program: </p><p>School/Institution: </p><p>Date Course Begins: ______</p><p>(1) Is the course required to meet minimum educational requirements for your current job? (Check one) Yes _____ No _____</p><p>(2) Does the course provide you with the capacity to qualify for a new job? (Check one) Yes _____ No _____</p><p>(3) Briefly explain how this course or program is either required to meet minimum educational requirements for your current job OR provides you with the capacity to qualify for a new job.</p><p>Are you pursuing a degree? Yes _____ No _____</p><p>If so, what degree: </p><p>Major: Minor: Number of hours completed thus far: </p><p>Other degrees previously completed: ______Major/Minor Major/Minor</p><p>Tuition: $ Books: $ Other Fees: $ TOTAL COST: $ </p><p>Other courses taken this year under the Academic Assistance Program:</p><p>Amount of Reimbursement $ ______</p><p>Amount of Reimbursement $ ______</p><p>Are you eligible for benefits under the G.I. Bill? Yes ____ No ____</p><p>Reimbursement received from G.I. or other scholarship grants: $ </p><p>I certify that the above information is correct and I understand that educational assistance payments for this course or program will be reported as taxable income to the IRS and will be subject to appropriate Federal and State income and payroll tax withholdings.</p><p>Employee’s Signature: </p><p>Date: ______</p><p>Department Director’s Approval: </p><p>Date: ______</p><p>HR Director’s Approval: </p><p>Date: ______</p><p>Administrator/CEO’s Approval: </p><p>Date: ______(THIS SECTION TO BE FILLED OUT AFTER COURSE IS COMPLETED)</p><p>The following course was completed on: (date) </p><p>List courses(s): </p><p>Grade received (Attach grade report): </p><p>Grade received (Attach grade report) ______</p><p>Expenses (Attach original receipts) Tuition $ Total Fees $ Books $ TOTAL $ Scholarship or Government Assistance Approved $ Net Cost $ Amount of Educational Assistance Approved $ </p><p>HR Director Approval for Payment: </p><p>Date Approved: </p><p>Employee Signature </p><p>Date: </p><p>NOTE: EMPLOYEES MUST BE ON ACTIVE COMPANY PAYROLL TO RECEIVE REIMBURSEMENT PAYMENTS.</p><p>Employees should be aware that the decision to report reimbursements for expenses is not conclusive as to deductibility. In such cases, employees should consult their own tax advisers regarding the application of the tax rules to their individual situation. ACADEMIC ASSISTANCE AGREEMENT</p><p>I, ______, hereby agree and acknowledge that Academic Assistance monies granted to me by Tehachapi Valley</p><p>Healthcare District (TVHD) in the amount of $ (as paid to ______) will be repaid to TVHD by me in the event of my resignation or changing my regular full-time status prior to one year from graduation or one year from receiving my license/degree.</p><p>I understand that up to $3,000 of reimbursement is forgiven for each 2 years of full time employment post graduation, and that resignation or discharge for cause prior to having all reimbursements forgiven will necessitate repayment to TVHD of the remainder.</p><p>I further understand that if I terminate my employment with TVHD within one year of receiving academic assistance, TVHD shall require full or partial reimbursement, per this signed agreement. </p><p>Employee Signature Date</p><p>Tehachapi Valley Healthcare District Management Date</p>