Sharpsville Area School District

Sharpsville Area School District

APPLICATION FOR INCENTIVE AND/OR TUITION REIMBURSEMENT

I AM APPLYING FOR: ____ Tuition Reimbursement ____ Incentive

APPLICANT’S NAME: ______

CERTIFIED INSTRUCTION AREA(S): ______

SUBJECT(S) CURRENTLY TEACHING: ______

NAME OF COLLEGE/UNIVERSITY: ______

COURSE TITLE: ______

COURSE NUMBER: ______CREDITS: ______

SEMESTER: ______TUITION CHARGE: $______

1. Have you completed your 24 hours required for permanent certification? __Yes __ No

2. Is this course applicable for the maintenance of your existing certification as required by State law? __ Yes __ No

3.  Is this course necessary for a degree you are working toward? __ Yes __ No

If yes, what degree? __ Masters __ M+30 __ M+60 __ M+90

Degree Name: ______

4.  Is this graduate course:

a. In your current teaching field? __ Yes __ No

b. In your certified field? __ Yes __ No

c. In the general education field? __ Yes __ No

d. In the administrative field? __ Yes __ No

5. Is this course recognized by the Pennsylvania Department of Education? __ Yes __ No

If no, please attach a letter from the State Department of Education where the

College/University is located, verifying confirmation of accreditation and/or

verifying the course is accepted by that state’s Department of Education.

APPLICANT’S SIGNATURE: ______DATE: ______

* THIS APPLICATION MUST BE SUBMITTED TO THE SUPERINTENDENT PRIOR TO THE START OF COURSE.

* A PROFESSIONAL EDUCATION REQUEST FORM MUST BE COMPLETED FOR ACT 48 CREDIT.

* A SYLLABI OF THE COURSE MUST BE TURNED IN WITH APPLICATION FOR CONSIDERATION.

ADMINISTRATIVE RESPONSE
Tuition: ___ Approved --- Amount Approved: $______
Amount of approved to be carried over to the next fiscal year $______
___ Not Approved
Reason not approved: ______
Incentive: ___ Approved --- Amount Approved: $______
___ Not Approved
Reason not approved: ______
______
Superintendent’s Signature Date

01/10*****

* TUITION - REIMBURSEMENT WILL OCCUR FOLLOWING THE NEXT REGULAR BOARD MEETING AFTER RECEIPT OF A GRADE CARD AND PROOF OF PAYMENT IS RECEIVED BY THE SUPERINTENDENT.

* INCENTIVE - GRADE CARDS MUST BE TURNED IN TO THE SUPERINTENDENT’S OFFICE BEFORE SEPTEMBER 1 OF THE YEAR IN WHICH YOU EXPECT TO RECEIVE COMPENSATION