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Course Reimbursement Approval Request 2019-20 School Year
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 *
Last Name *
Email Address *
Mailing Address *
School *
Position *
Subject Area/Grade Level *
Course Information
Title of Course *
Include Course Number
University/College *
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.
Trimesters Defined *based on the end date of the course
SUMMER 2019-20 Course: Ending between 07/01/19 - 08/31/19
FALL 2019-20 Course: Ending between 09/01/19 - 12/31/19
SPRING 2019-20 Course: Ending between 01/01/20 - 06/30/20
Date Course Begins *
Date Course Ends *
Course Level *
Is this course for initial certification? *
The maximum reimbursement is determined by contract. Please refer to your collective bargaining agreement.
Number of Credits *
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.
Registration Fee
Please refer to your collective bargaining agreement to determine if you are eligible for text/materials reimbursement.
Employee Signature *
Date *
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