CERTIFICATED

TEA

CREDIT REIMBURSEMENT APPLICATION

Name ______

Site ______

Instructions:

  1. Applications must be submitted complete with a copy of the receipt and a grade report for each course attached to the reimbursement form. Receipts must be printed with name, date of course or indication of school term and detail of tuition paid. Reminder: fees (i.e.: technology, parking, graduation, etc.) will not be considered for reimbursement.
  1. Credits must be earned from a regionally accredited institution of higher education and meet all criteria of WAC 392-121-255.
  1. A Certificated Course Approval must be on file for credits or clock hours submitted for reimbursement.
  1. Reimbursement applications are due by September 30 of the current year for courses completed in the previous school year (September 1 to August 31.) In cases when September 30 falls on a weekend, the deadline will be 8 a.m. of the immediately following Monday.
  1. Clock hours earned in the National Board for Professional Teaching Standards (NBPTS) process (45 clock hours for completion of the assessment process and an additional 45 clock hours upon completion of the National Boards process) are eligible for reimbursement. These clock hours will be converted to quarter credit hours.
  1. Clock hours earned through additional coursework that directly supports the National Board process are eligible for reimbursement.For example, coursework that provides guidance in understanding the standards, portfolio support, reflective writing, and how to correctly submit information to the National Board would be approved.
  1. No other clock hours will be considered for reimbursement.

List course information on reverse.

Employee SignatureDate

Authorized District Office Official SignatureDate

NOVEMBER

Total Amount to be Reimbursed (Filled in by District Office Only)Payment Due

Course Title:

College or Provider:

Date Course Approved: Date Course Completed:

Number of: Semester Credits  Quarter Credits Clock hours

Cost Incurred:

NOTE: Reimbursement is limited to tuition/instructor cost incurred during the current school year, and submitted for reimbursement the following September.

…………………………………………………………………………………………………………….

Course Title:

College or Provider:

Date Course Approved: Date Course Completed:

Number of:  Semester Credits  Quarter Credits Clock hours

Cost Incurred:

 NOTE: Reimbursement is limited to tuition/instructor cost incurred during the current school year, and submitted for reimbursement the following September.

…………………………………………………………………………………………………………….

Course Title:

College or Provider:

Date Course Approved: Date Course Completed:

Number of:  Semester Credits  Quarter Credits Clock hours

Cost Incurred:

 NOTE: Reimbursement is limited to tuition/instructor cost incurred during the current school year, and submitted for reimbursement the following September.

Cert Credit Reimbursement/khRev 1/2011