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Tuition Reimbursement

  1. Instructions*
  2. List course for which tuition reimbursement is requested:
  3. If grade is other than A,B,C,D, F, please explain.
  4. If grade is other than A,B,C, please explain.
  5. If grade is other than A,B,C, please explain
  6. Acknowledgement*
    I have read and understand the Town's Tuition Reimbursement Policy. I agree that I will remain employed with the Town of Frederick for a minimum of two years after the completion of the above classes. If I voluntarily leave employment with the Town prior to this obligation being met, I will reimburse the Town the full amount of assistance receive. I expressly authorize the Town of Frederick to deduct any amount due to the Town from any Paycheck(s) including but not limited to my final paycheck, in accordance with state and federal law.
  7. Human Resources Notification
    Supervisors: Once approved, please make sure to forward response to the Human Resources Director.
  8. Leave This Blank:

  9. This field is not part of the form submission.