COMMONWEALTH OF PENNSYLVANIA
MUNICIPAL POLICE OFFICERS’ EDUCATION AND TRAINING COMMISSION
8002 Bretz Drive
Harrisburg, PA 17112-9748
REQUEST FOR REIMBURSEMENT UNDER ACT 120, 1974
INSTRUCTIONS
GENERAL
This form will be the application used by all submitting agencies who request reimbursement from the Municipal Police Officers’ Education and Training Commission for expenditures related to a hired officer’sapproved basic training that was provided by a Commission certified school.
BLOCK INSTRUCTIONS
1.Date of Application.
2.Federal ID # - Unique federal identification number assigned to a business.
3.SAP Vendor # - A unique number assigned to a municipality, vendor, or other service provider, enabling submission and payment of invoices through the Commonwealth SAP computer system.
4.Invoice Number – Submitting Agency’s SAP vendor number – Year in which reimbursement is being requested – a sequential number of all requests submitted to the Commission for that year (e.g.123456-2015-01,
123456-2015-02).
5.Officer’s Name – Last name, First Name, Middle Initial.
6.Officer’s Social Security Number – self-explanatory.
7.Date of Hire – Date officer was hired with police department.
8.Is the Officer Employed with your department full-time or part time?
9.Police Department’s Telephone Number – self-explanatory.
10.Name of Police Department – self-explanatory.
11.Email Address – Email address of person signing Block 18.
12.Police Department Address - A police department address must match exactly to SAP vendor #. If the address is different, the reimbursement request will be rejected. It is recommended to verify SAP address as submitted in Commonwealth SAP computer system.
13. County – County in which the municipality/police department is located.
14. Commonwealth Certified School - Who provided the training (e.g. – name of school).
15.Dates Attended School – Beginning and end dates of basic training.
16.Tuition –Amount of tuition charged by the certified school for basic training. Complete computations and submit a copy of officer’s invoice from certified school, the grade sheet, and the diploma.
17.Salary – Officer’s base hourly salary without benefits. Complete computations, and submit a copy of officer’s payroll record for the dates contained in Block 15.
18.Signature of Police Chief or Municipal Official and date of signature.
Page ___ of ____. Page number and toal number of pages being submitted.
Any questions or concerns please contact MPOETC at 717-346-4086.