Supplemental Educational Assistance Allowance
Reimbursement Request Form
This form is designed to be completed in electronic format and routed via email, whenever possible. Editing is
limited to the fillable fields. Press “Tab” to move from field to field, or click on the desired field using a mouse, and
then enter the appropriate information.
In order for an employee to qualify for reimbursement, Human Resources must receive this form with Steps 1
through 3 completed, prior to beginning the requested training activity. Steps 1 and 2 are to be completed by the
employee and Step 3 is to be completed by the supervisor. The employee will be notified by email when the request
is approved. Upon finishing the approved training, Step 4 must be completed for the employee to receive
reimbursement. Read Policy 2.25(b) Supplemental Educational Assistance Allowance for program details.
Step 1 – Pre-Approval Information (Employee to complete all fields and proceed to Step 2)
Employee Name:
Title of Training:
Date of Training:
Brief Description of Training Activity:
Relevance to Position:
Email Address:
Training Organization:
Amount of Reimbursement Requested:
Step 2 – Employee Acknowledgement
By typing my name below and emailing this form to my supervisor, I certify that the information I have provided is
truthful and accurate to the best of my knowledge. I also certify that I am not receiving any financial aid that would
result in a duplicate payment for this training activity.
Electronic Signature:
Date:
Step 3 – Supervisor Approval
In order to approve your employee’s training request:
1. Complete the electronic signature and date below.
2. Forward your employee’s original email, with this completed form attached, to Human Resources.
By typing my name below, I approve the requested reimbursement.
Electronic Signature:
Date:
Step 4 – Proof of Payment and Completion
In order to receive reimbursement for a completed training activity, email scanned copies of the following to Human
Resources:
1. Proof of Payment (Examples include a copy of receipt, paid invoice, credit card statement, etc.)
2. Proof of Completion (Examples include a copy of a certificate, email confirmation from presenter, etc.)
If it is not possible to scan proof of payment and completion, hard copies may be mailed or dropped off to Human
Resources.
Rev. 9/2011