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City of Eugene <br />Request for Educational Aid <br />Reimbursement of the tuition cost of educational courses up to a maximum allowance of the full cost per course will be made when <br />the following qualifications are met: <br />1. The course work must be such that, in the judgment of the City, it will be of value to the City and the employee. <br />2. No duplication of reimbursement will be made if the employee is receiving assistance through other means, scholarship, <br />grant, fellowship, Of Bill, or other government assistance. ' <br />3. The course must be approved by the Supervisor and Division Manager prior to enrollment. <br />4. Evidence of satisfactory completion (pass or "C" or above) of the course and receipts for tuition must be submitted to the <br />Office Manager prior to reimbursement. <br />5. No reimbursement for books will be provided. <br />6. AFSCME Employees may request to use a flex schedule to allow them to attend classes. This flex -time request must not <br />negatively impact the work group and the employee's timesheet must still equal forty hours worked within each work <br />week. <br />T Funding level will be determined by benefit to the City, relationship of the course to the employees currentdutiesorformal <br />career development plan and the availability of funds. <br />I have discussed the above information with my supervisor and understand the guidelines listed above. Ifurther understand that must <br />remain employed by the City of Eugene for one year after the completion of this course, or I must refund to the City 50% of the tuition <br />assistance received through a payroll deduction. If my employment is terminated due to a reduction in force, this repayment provision <br />will be waived. <br />Employee Signature Date Supervisor Signature Date <br />Name: <br />Department: <br />Job Title: <br />Title of Coursers): <br />Name of School: <br />Date Course Begins: <br />Approximate Completion Date: <br />Estimated Tuition Costs: <br />Please provide a short description of the class, how it fits into your training, career and or personal development goals and <br />what knowledge, skills and abilities you intend to learn: <br />❑ This course will not benefit the City. Not approved for reimbursement at this time. <br />❑ This course will benefit the City; adequate funds have been budgeted for this expenditure. <br />Authorized Amount of Aid: $ <br />Supervisor: Department Head: <br />' x <br />+ ,47,74c,, -�k .i X .sad*.,+, vS > <br />.,. Y �• 'S S hx. ^ -C` „"a '^,. <br />e..i?F.�UWtn`Q¢+ <br />3 DXyRDRaYittttbgfu <br />�yYnj�CJjI�{..P <br />http: / /ceshare /cs/hr/ Documents /Education_Aid_Request.doc Last <br />updated 10 /0112010 <br />