Construction Fundamentals Tuition Reimbursement Application Form

"*" indicates required fields

Note: You must submit your application and required documentation to GBCA within two weeks after receiving your final grade.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Employment Information

Current Employer*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Job Title / Position*

Date of Employment*

Previous Employer

Address

Street Address Address Line 2 City State ZIP Code

Job Title / Position

Supervisor Name

First Last

Supervisor Phone

Supervisor Email

Date of Employment

Course Details

Course Name*

Course Start Date*

Course End Date*

Course Amount*

I submit this application with the understanding that GBCA will reimburse me the allowed amount, provided I have been approved for reimbursement and meet all eligibility requirements. I understand that I am responsible for paying the course fee upfront. Reimbursement will only be issued if I achieve a grade of B or higher in the course. I acknowledge that if I drop the course or receive a grade lower than B, I will be ineligible for reimbursement.

By completing this information you authorize GBCA to obtain an official copy of your grades at the end of the semester. Questions may be directed to Marybeth Gerdelmann, Education & Workforce Development Associate, by email at mgerdelmann@gbca.com, or Meg Ginsberg, Training & Professional Development Manager, by email at mginsberg@gbca.com or by telephone at (215) 568-7015.

Check this box if you agree with the terms above.

By agreeing with the terms below, I am indicating I understand that reimbursement will be contingent upon achievement of letter grade B or higher in the course listed on this application, that I am solely responsible for payment to the institution listed above for this course, that upon completion of the course I have thirty (30) day to provide proof of payment and an official transcript to GBCA. I understand I am solely responsible for the payment of any additional tuition cost or fees, including textbook costs and late fees. I understand that if I do not complete this course, for voluntary or involuntary reasons, I will be ineligible to participate in the GBCA Tuition Reimbursement Program for one year, effective from the date of this application.

Check this box if you agree with the terms above.

Comments

This field is for validation purposes and should be left unchanged.