Carpenter Apprenticeship Tuition Reimbursement Program Pre-Registration Form

You are required to pre-register with the GBCA by filling out the pre-registration form. Upon approval from GBCA, you must register at the appropriate educational institution.

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Name

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Tuition Reimbursement Pre-Registration Form

Note: You must apply with GBCA within 30 days of the start of your class, and your invoice and transcript must be sent to GBCA within 30 days of the completion of your course.

Application Information

Name*
First Last

Address*
Street Address Address Line 2 City State ZIP Code

Phone*

Fax (optional)

Email*

Employment Information

Current Employer*

Address*
Street Address Address Line 2 City State ZIP Code

Phone*

Job Title / Position*

Date of Employment*
MM slash DD slash YYYY

Previous Employer (optional)

Address (optional)
Street Address Address Line 2 City State ZIP Code

Phone (optional)

Job Title / Position (optional)

Date of Employment (optional)
MM slash DD slash YYYY

Course Details

Course Number & Name*

Course Start Date*
MM slash DD slash YYYY

Course End Date*
MM slash DD slash YYYY

Course Tuition Amount*

Applicant Agreement

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 Coordinator, by email at or by telephone at (215) 568-7015.

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.

Signature*
Please provide your signature if you agree with the terms above.