TO BE COMPLETED BY EMPLOYEE:
Proposed Course of Study:
Have you been admitted? Undergraduate Graduate Special
UW-Madison UW-EXT MATC Other
Number of credits:
Total fee and tuition:
When is/are the course/s offered?
What is the relationship between the course/s you want to take and your present position?
Have you been reimbursed for training before? Cite dates and study undertaken:
EMPLOYEE SIGNATURE__________________________________ Date:______________
Note: In order to be eligible for reimbursement, an employee must continue employment in state service after successful course completion.