Course Reimbursement Approval Request 2017-18
1) No reimbursement will be issued unless this form is signed by the Superintendent / Asst. Superintendent prior to the starting date of the course.
2) Please reference your negotiated contract and /or policies for additional information regarding reimbursement of courses.
3) To obtain reimbursement after completion of course, a grade report is acceptable; please attach to blue Course Reimbursement Form. HOWEVER PLEASE REMEMBER, if you are applying for a salary track change, a grade report is not acceptable - you must submit an official, signed/sealed transcript. Please refer to your collective bargaining agreement for the deadlines for track change submissions.
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
School *
Position *
Your answer
Subject Area/Grade Level *
Your answer
Course Information
Title of Course *
Include Course Number
Your answer
University/College *
Your answer
Course Description *
Please describe this course. Include briefly how this course will impact the achievement of your students. Please also include information regarding how you plan to share information from this professional development activity. Specify the team(s), individual(s) and/or group(s) of interest and time frame you believe will work.
Your answer
Trimesters Defined *based on the end date of the course
SUMMER 2017-18 Course: Ending between 07/01/17 - 08/31/17
FALL 2017-18 Course: Ending between 09/01/17 - 12/31/17
SPRING 2017-18 Course: Ending between 01/01/18 - 06/30/18
Date Course Begins *
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YYYY
Date Course Ends *
MM
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DD
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Course Level *
Is this course for initial certification? *
Expenses
The maximum reimbursement is determined by contract. Please refer to your collective bargaining agreement.
Number of Credits *
Your answer
Cost per Credit *
NOTE: Reimbursement will not exceed the current UNH (in-state) cost per credit and in no instance be more than the ACTUAL cost involved.
Your answer
Registration Fee
Your answer
Text/Materials
Please refer to your collective bargaining agreement to determine if you are eligible for text/materials reimbursement.
Your answer
Employee Signature *
Your answer
Date *
MM
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DD
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YYYY
Submit
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