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Educational Assistance Approval Form Complete the information below and include any supporting documentation regarding the content of the courses to be taken. Form must be completed and approved prior to class registration. Employee Name : Job Title: Department: Date of Hire: Department Head/Director Name: Applicant’s declared major of study (if applicable): Full Name of Educational Institution: Working toward a degree? YES NO Describe purpose of taking course(s): Course Title Credit Hour Tuition Cost Start Date: End Date: Employee Signature Date Please refer to the policy for details on eligible expenses and grade criteria. I understand that I am to attend courses on my own time. If my employment is terminated, for any reason with the City, within two years of reimbursement, I agree to pay back the City, in full, for tuition reimbursement/assistance, paid by the City, within 30 days of my termination. SIGN ---PAGE BREAK--- Approved Declined; If declined, state the reason: Department Head/Director Date Approved Declined; If declined, state the reason: HR Director Date City Manager Date If declined, date the employee was informed: For HR Use Only Approved Declined; If declined, state the reason: