A Tuition Reimbursement Request Form: A Case Study

Tuition Reimbursement Request Form

For information on the tuition reimbursement program go to: http://www.lbl.gov/BLI/forms.html
For information on the Education and Employee Development Policies, go to: http://www.lbl.gov/Workplace/RPM/R2.04.html

A Tuition Reimbursement Request form must be completed prior to registering for a course.

Steps for Approval

Complete Section I of the Tuition Reimbursement Request form completely. Forms requiring additional information will be returned to you and may result in delays.

Obtain your supervisor’s approval as well as that of your division director/department head as required by your division.

Note to supervisors, division directors and department heads: Approval of tuition reimbursement
Send the completed and signed form to the Tuition Assistance Program Coordinator at
MS 4-230 for approval. Form must be submitted at least three weeks before you register. If you are also applying for a Tuition Advance, submit this following form along with the Tuition Reimbursement Request form and allow two weeks for approval of the Tuition Advance. http://www.lbl.gov/BLI/forms.html

The approved original forms will be returned to you to be retained until the end of the quarter/semester.

If you cannot enroll in a class listed on the Tuition Reimbursement Request form, inform the Coordinator as soon as you register by emailing [e-mail] and send a copy to your supervisor. Explain the reason for not enrolling (e.g., class full, class not offered this quarter/semester) and provide the relevant information for any substituted
3. Is the education required by LBNL or by law to keep the employee’s current salary or job?  Yes  No
4. And/or does the education maintain or improve skills needed in the current job?  Yes  No

If the answer to 3 or 4 is “Yes”, the employee’s tuition assistance is not subject to withholding of taxes.

NOTE: Even if the answer to 3 and/or 4 is "Yes", if either of the answers to 1 or 2 is "Yes", then tuition is taxable.

I understand that I am solely responsible for payment of taxes as a result of any reimbursement for education that may be found to be taxable. I understand also that LBNL’s tax withholding policy and any decision to withhold or not withhold taxes from educational reimbursements to me do not constitute tax advice and I agree to hold LBNL harmless from any claim associated with LBNL’s withholding of payroll taxes. I will submit grades and receipts within 45 days of the end of the term to the Tuition Assistance Program Coordinator.

Employee Signature

Date
Supervisor Signature
Date
Department Head or Division Director Signature