EDUCATIONAL REIMBURSEMENT FORM

IN ORDER TO BE REIMBURSED: you must submit this form within sixty (60) work days after the availability of semester grades and upload the following below:

1. ENROLLMENT AND PAYMENT PRINTOUT

2. COPY OF GRADE REPORT 

3.  BOOK RECEIPTS (for required books)

This form is to be used to request reimbursement for the successful completion of courses taken at El Camino College by regular permanent employees, their spouses, and/or their legal dependent children. Fees are reimbursed for successfully completed courses upon completion of semester. Only employees are eligible for book reimbursement (for required books purchased with 10% employee discount at the El Camino College Bookstore).

Employee's Name*
Address*
Colleague ID
Student's Name*

EMPLOYEE ELIGIBILITY CHECK LIST

Are you a non-probationary employee?*

STOP - Please do not proceed. You have to be a permanent (non-probationary) employee in order to qualify for a educational reimbursement. 

Are you applying for yourself, your spouse, or a legal dependent?*

STOP - Please do not proceed. You can only apply for yourself, spouse, or legal dependent.

Are you on approved medical or disability leave?*

If you are on approved medical or disability leave, you must submit formal written request through the Exceptions Committee. 

REIMBURSEMENT REQUESTED

$
$
$
$
Books must be purchased with 10% employee discount at the El Camino College Bookstore
$

DOCUMENTATION REQUIRED

No File Chosen
File uploads may not work on some mobile devices.
Registration Statement - can be obtained from the cashier's window (next to the bookstore)
No File Chosen
File uploads may not work on some mobile devices.
Grade Report must include the semester, year, and grade issued for the class.
No File Chosen
File uploads may not work on some mobile devices.
Only book receipts from the El Camino College Bookstore are acceptable for reimbursement.

HR TECHNICIAN REVIEW

Is the application approved/complete to go to the HR Director?*

Classified Account Number:

11-55250-00-67300-8500

ECCPOA Account Number:

11-55251-00-67300-8500

Confidential Account Number: 

11-55252-00-67300-8500

Faculty Account Number:

11-55254-00-67300-8500

Account Code: *

HR MANAGEMENT REVIEW

HR Director's Name*
HR Director's Decision*

ACCOUNTING REVIEW

Is the total refund amount the same as above?*