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MSAD33 Course Reimbursement Form
In accordance with bargaining agreements, tuition reimbursement will be contingent upon a grade of no less than a "B."
Name
*
First
Last
School
*
Dr. Levesque Elementary
Wisdom Middle/High School
St. John Valley Technology Center
Other
Course start date?
*
MM
/
DD
/
YYYY
Course end date?
*
MM
/
DD
/
YYYY
Total Reimbursement Request
*
$
Dollars
.
Cents
Upload tuition invoice from the university or college.
*
Add File
Scan or take a digital photo of your tuition invoice.
Upload evidence of passing grade from the university or college.
*
Add File
Scan or take a digital photo of your passing grade.
Signature
*
Clear
By signing here, I acknowledge that the information provided is accurate to the best of my knowledge.
