The listing provides information regarding the publix reimburse form. It's a good idea that you read this info before you decide to begin filling out the form.
| Question | Answer |
|---|---|
| Form Name | Publix Reimburse Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | reimbursable, TuitionReimbursementPublix, publix tuition reimbursement, Avg |
Tuition Reimbursement Program
Undergraduate Reimbursement Request Form
Instructions
After each class ends the Tuition Reimbursement department must receive a completed copy of this form, a copy of your grade report, and an itemized receipt (showing a breakdown of your tuition cost for each class and the method/s of payment) within 45 days for it to be considered for reimbursement.
Publix Super Markets, Inc.
Human Resources/Tuition Reimbursement Program P.O. Box 407
Lakeland, FL
If you have any questions about the Tuition Reimbursement Program we can be reached at (863)
Associate Information
Name: ____________________________________________________ Publix Personnel Number: ___________________
Job Title: ________________________________________ Email Address: _______________________@_____________
Store Number or Support Department Name: ________________________________ Division: _______________________
Are you interested in pursuing a career with Publix after graduation?
Yes
No
If yes, in what capacity or department? ____________________________________________________________
Are you willing to relocate after graduation for a career with Publix?
Yes
No
Depends
What is your long term career goal?_________________________________________________________________________
School & Course Information
School Attended: ___________________________________
Declared Major: ________________________________
Current Classification: |
Freshman |
Sophomore |
Class(es) taken during: |
Spring |
Summer |
Expected Graduation Month and Year: _________________
Is this your last course before graduating? Yes No
Junior |
Senior |
Fall |
Winter |
Course #
Course Title
Start Date
End Date
Credit Hrs
Grade
Payment Information - from your attached receipt(s) |
Reimbursement Criteria |
Total Tuition Cost |
$ |
|
|
Methods of Payment |
Amount of Payment |
|
|
Grants and/or Scholarships* |
$ |
Loans and/or Prepaid Tuition |
$ |
|
|
Cash, Check, Money Order and/or Credit Card |
$ |
|
|
* Tuition expenses that were paid for with grants or scholarships are not reimbursable.
For Office Use Only
To be eligible to receive reimbursement, you must
be a current and approved Tuition Reimbursement participant on the date funds are scheduled to be disbursed
pursue a qualifying major at a regionally accredited school
be an active associate with at least six months of consecutive service since your last hire date
maintain a minimum average of 10 work hours per week based on a 52 week average or entire employment if employed less than 1 year
maintain a minimum Total Performance Rating of Meets Expectations/Successful and
receive a grade of “C” or better in the class
Last Hire Date: _____/_____/______ |
Avg Number of Hours: __________ |
Did the associate’s major change? |
Reimbursement is: |
|
Did the associate change schools? |
Approved in the amount of $________________________________ |
Met annual limit? |
|
Denied because__________________________________________ |
Met lifetime limit? |
|
Yes No
Yes No
Yes No
Yes No
Initial _________ Date _____/______/_______ |
061710 |