Milwaukee Area Technical College

Milwaukee Area Technical College

TUITION REIMBURSEMENT APPLICATION Professional Development Department

FOR NONREPRESENTED EMPLOYEES 700 West State Street Room M201

Milwaukee, WI. 53233 414-297-6912

INSTRUCTIONS: (PLEASE TYPE IN THE SHADED AREAS AND THEY WILL EXPAND)

1. Read the Guidelines on the back of this application. 6. The Professional Development Department will retain the original copy
2. Provide a separate application for each course. in their files and you should keep a copy for your records.
3. Complete Parts I-V. 7. To receive your reimbursement you must submit a PHOTOCOPY of a
4. The requested "race" "gender" information in Part I is for grade report or notice of completion & the yellow Request for
MATC's Affirmative Action Program. Select one for race (Check One): Reimbursement Form within 8 weeks of the ending date of the course.
African American , American Indian or Alaskan Native , Asian or Pacific 8. If you do not follow the instructions and guidelines, your reimbursement
Islander , Caucasian , Hispanic may be canceled.
5. Submit the approved application to the Professional Development 9. Please notify the Professional Development Department of any change of
Department with PHOTOCOPIES of all tuition receipts no later home address or name.
than 4 weeks after the starting date of the course. (Receipts will not 10. If you are unable to meet these requirements contact the Professional
be returned.) Development Department.

PART I – APPLICATION INFORMATION

Name Last, First , Initial
/ Home Address Zip Code
Department, Division
/ Phone Ext.
/ Email Address
/ Job Title
/ Gender
Male
Female

PART II – COURSE INFORMATION

Course Title
/ School/College
/ Starting Date
/ Ending Date
/ Credits
Course Description – Explain how course relates to current job or reasonable promotional opportunity
/ Degree Pursued
Type of
Course Undergraduate Course Graduate Course
(see guideline #9) / Reason for Job Related
Taking Course Promotional Opportunity / Tuition (Receipt Required)
$

PART III – ELIGIBILITY FOR OTHER EDUCATION BENEFITS. MATC will not reimburse employees who are eligible for other education benefits.

Are you eligible for other educational benefits? / Yes
No / If yes, please describe

PART IV – APPLICANT SIGNATURE. I have read the instructions and guidelines on this application and understand that the course must be approved by my supervisor, department head and the Professional Development Department.

Signature / COSMO ID / Date

PART V – SUPERVISOR AND DEPARTMENT/DIVISION HEAD DETERMINATION. Please complete Part V and send to the Professional Development

Department

This course does does not appear to be related
to the applicant's present position or to a reasonable
promotional opportunity with MATC.
Signature of Supervisor Signature of Dept./Division Head
Time used for course/seminar employee's own time flexible schedule
(check one) compensatory time vacation / Comments

-DO NOT WRITE BELOW THIS LINE-

PART VI – DEPARTMENT/DIVISION HEAD – PROFESSIONAL DEVELOPMENT DEPARTMENT –

Yes / Approved by
/ Comments
/ Tuition
/ Total Amount
Reimbursed (YTD)
Disapproved
Reduced Reimbursement
Previous Tuition Reimbursement
This Year $ Total now / Grade or Completion Date
/ Receipt in
Yes No / Tuition
$ / Date
Cancellation Entered / Request for Payment Memo Sent
/ Date Paid

Incomplete or incorrectly completed application will be returned to the employee .

Milwaukee Area Technical College