Tuition Reimbursement Form - University of Wisconsin-Madison

UNIVERSITY OF WISCONSIN – MADISON
Reimbursement Request for Career‐Related Education for Classified Employees
This form is not to be used for training that is required or directed by the employer and is essential for job performance in the current position.
Refer to CHR policies and procedures Appendix 12 – A for information on how to process payment for required training.
TO BE COMPLETED BY EMPLOYEE:
Employee Name:
Employee Job Title:
Employing Unit/Department/Division Name:
Address:
Please check one: Represented Non‐represented
If Represented, Bargaining Unit:
Proposed Course Title(s) and Number(s):
Name of Institution of Higher Education:
Have you been admitted Yes No
Undergraduate Graduate Other (specify):
Semester Offered: Fall Spring Summer Year Offered:
Number of Credits: Total Fees and Tuition to be Reimbursed: $
What day(s) of the week and time is/are course(s) offered :
How many hours per week leave without pay are requested
How will this course aid you in your current job, or to progress within the bargaining unit or to move laterally within the
University
Employee Signature: ________________________________________________ Date: ______________
Submit this form to the authorized person in your employing unit for review, completion and approval.
_____________________________________________________________________________________
(over)

TO BE COMPLETED BY EMPLOYING UNIT/DIVISION PERSON AUTHORIZED TO ANSWER QUESTIONS BELOW:
Indicate Name:
Title:
Will this course aid the employee in his/her current job, or to progress within the bargaining unit, or to move laterally
within the University Yes No
If no, stop and return this form to the employee. Tuition reimbursement is not approved.
If yes, enter the following:
Fund/Account to be charged:
*Amount reimbursement committed:
*REFER TO APPENDIX 12‐B in the online Classified Policies & Procedures for percentage of reimbursement required by each
contract.
(Signatures below as required by employing unit policy)
Supervisor: ________________________________________ Date: _____________
Department Chair: _________________________________________ Date: ________________
Dean or Director: __________________________________________ Date: ________________
Classified HR (required): ____________________________________ Date: _______________
Updated August, 2010
Tuition is reimbursed through the e‐Reimbursement system, using the “Other Non‐Travel” expense type. This
prior approved form, proof of successful completion of course work* and a receipt for tuition payment must be
included when the expense report is submitted to the department’s e‐Reimbursement approver. The approver
must replace account code 3101 and enter the account code of 2180 or 2181 for all career‐related tuition
reimbursements.
* Proof of successful completion is typically a grade report or a letter from the registrar.