/ Office of Business and Finance/Division Talent and Labor Relations
201 N. Front Street, 6th Floor • Camden • NJ • 08102
Telephone 856-966-2000 ext. 38830 • Fax 856-966-2186

Camden City School District

Application for Tuition Reimbursement

Part 1: Applicant Information

Full Name: /
Hire Date:
/ Click here to enter a date.

Last

/

First

/

M.I.

Address:

Street Address

/

Apartment/Unit #

City

/

State

/

ZIP Code

Phone: /
Email
Current Job Assignment:

Part 2: School Information

Attending College: / Date of Click here to enter a date.
Registration:
Course Title and Number:
# of Credits: / Semester: / Year:
Course Title and Number:
# of Credits: / Semester: / Year:

Part 3: Job Description Appropriate Rationale

Please indicate the reason for taking the course(s) listed above:

To be eligible for reimbursement, there must be compliance with the terms and conditions of the union or employment contract, Policy 6472 (Tuition Assistance) and NJAC 18A:6-8.5

Signature: / ______ /
Date:
/ ______
DO NOT WRITE BELOW THIS LINE
______
TUITION REIMBURSEMENT
APPROVED DENIED
Superintendent Signature: / ______ / Date: / ______

cc: personnel file