Berklee Tuition Reimbursement

Berklee Tuition Program Reimbursement Request Form

Prior to taking your course, complete and send this form (with supervisor approval) to Benefit Strategies at least 45 days prior to the start of your course.

Employee Information

Employee Name*

First Name

Last Name

Employee ID*

Email*

Do you work for the College or the Conservatory?*

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Supervisor's Name*

First Name

Last Name

Supervisor's Email*

Institution Information

Name of Educational Institution*

Degree Type*

Course Information

How many courses are you filing for?*

Course 1 Information

Course Title*

Course Start Date*

Course End Date*

Total*

Upload Proof of Cost (Itemized bill from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Proof of Payment (Receipt from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Grade(s)/Proof of Course Completion

No File Chosen

File uploads may not work on some mobile devices.

Course 2 Information

Course Title*

Course Start Date*

Course End Date*

Total*

Upload Proof of Cost (Itemized bill from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Proof of Payment (Receipt from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Grade(s)/Proof of Course Completion

No File Chosen

File uploads may not work on some mobile devices.

Course 3 Information

Course Title*

Course Start Date*

Course End Date*

Total*

Upload Proof of Cost (Itemized bill from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Proof of Payment (Receipt from school)*

No File Chosen

File uploads may not work on some mobile devices.

Upload Grade(s)/Proof of Course Completion

No File Chosen

File uploads may not work on some mobile devices.

Acknowledgement and Agreement

I have thoroughly read and agree to all terms and conditions outlined in the Tuition Reimbursement Program Policy. I both acknowledge and agree my digital signature below represents my compliance with the terms and conditions outlined in said policies.

Employee Name*

First Name

Last Name

Please Note: This application may take two [2] weeks to process from receipt of all necessary information. Processing of this application does not guarantee tuition reimbursement.