Course Number Course Title Hours Course Delivery Start Date End Date Start Time Click Below Classroom Click Below Online End Time Other *Educational Leave Request (Refer to Instructions) Course Not Approved / Reason: Credit Type of Course Course Number Course Title Hours Start Date Course Delivery End Date Start Time Click Below Classroom Click Below Online End Time Other *Educational Leave Request (Refer to Instructions) Course Not Approved / Reason: Credit Type of Course Course Number Course Title Hours Start Date Course Delivery: End Date Start Time Click Below Click Below Classroom Online End Time Other *Educational Leave Request (Refer to Instructions) Course Not Approved / Reason: I certify that the above is true to the best of my knowledge. I understand that educational leave is not an absolute right and is subject to supervisory approval and that reimbursement is conditional upon satisfactory course completion, availability of funds and that reimbursement may be subject to withholding and FICA taxes. I, hereby, will release my course attendance and grade records for all courses I am seeking reimbursement. Selective Service (NCGS 143B-421.1): I am not eligible I am eligible and registered SECTION III – Approval AGENCY APPROVAL Number of Courses Submitted for Approval: Tentative Amount to be Reimbursed: $
Course Number Course Title Hours Course Not Approved / Reason: Course Delivery Classroom Online Other Start Date Click Below End Date Click Below Start Time End Time *Educational Leave Request (Refer to Instructions) Course Number Course Title Credit Hours Type of Course Course Not Approved / Reason: Course Delivery Classroom Online Other Start Date Click Below End Date Click Below Start Time End Time *Educational Leave Request (Refer to Instructions) Course Number Course Title Credit Hours Type of Course Course Not Approved / Reason: Course Delivery: Classroom Online Other Start Date Click Below End Date Click Below Start Time End Time *Educational Leave Request (Refer to Instructions) I certify that the above is true to the best of my knowledge. I understand that educational leave is not an absolute right and is subject to supervisory approval and that reimbursement is conditional upon satisfactory course completion, availability of funds and that reimbursement may be subject to withholding and FICA taxes. I, hereby, will release my course attendance and grade records for all courses I am seeking reimbursement. Selective Service (NCGS 143B-421.1): I am not eligible I am eligible and registered SECTION III – Approval AGENCY APPROVAL Number of Courses Submitted for Approval: Tentative Amount to be Reimbursed: $
AcademicAssistForm_0.docx