Publix Reimburse Form PDF Details

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Form NamePublix Reimburse Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesdisbursed, ext, Avg, reimbursable

Form Preview Example

Tuition Reimbursement: Undergraduate Reimbursement Request

(pursuing an associate’s or bachelor’s degree)


For a class to be considered for reimbursement, send the following to the Tuition Reimbursement department within 45 days of class completion:

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).

Once your request is processed, you’ll receive an email at the address you provided in PASSport and from your immediate supervisor/manager. If you do not receive an email within four weeks, please contact us.

Tuition reimbursement department

If you have Tuition Reimbursement Program questions, visit > Career and Self Development > Tuition Reimbursement Program or contact us.




688-7407 ext. 55999




Address: Publix Super Markets, Inc.

Human Resources/Tuition Reimbursement Program P.O. Box 407

Lakeland, FL 33802-0407

When contacting us, please provide your Publix personnel number (located on your pay statement).

Associate information


Personnel number

Personal email address



Verify your email address in




Job title

Store number or support department name




School and course information

School you attended

Declared major*

Expected graduation month and year

Is this your last course before graduating?


Current classification




Class(es) taken during:




















Course #



Course Title


Start Date

End Date

Credit Hours

































































*Specializations added to any of the approved majors could disqualify an associate from receiving tuition reimbursement (e.g., any degree that includes a specialization such as supply chain management would not be approved). It is the responsibility of the associate to verify whether a specialization would result in disqualification.

Payment information – from your attached receipt(s)

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 paid for with grants or scholarships will not be reimbursed.

Reimbursement criteria: To be eligible to receive reimbursement, you must

be a current and approved Tuition Reimbursement Undergraduate participant on the date that your classes ended

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 one year

maintain a minimum Total Performance Rating of Meets Expectations on your performance evaluation

receive a grade of “C” or better in the class and

be an active Publix associate on the date funds are disbursed.

Note: The entire amount of your tuition reimbursement is subject to income taxes. Federal and state income tax withholding (if applicable) and Social Security and Medicare taxes (FICA taxes) will be deducted from your tuition reimbursement funds. Federal income tax will be withheld at a 25% supplemental income tax withholding rate. The gross amount of your tuition reimbursement funds will be included in Box 1 of your Form W-2.

Updated: 05/17/2016

How to Edit Publix Reimburse Form Online for Free

Our top level web programmers worked hard to create the PDF editor we're delighted to present to you. Our app helps you quickly fill in Publix and can save your time. You just have to stick to this particular guideline.

Step 1: The initial step would be to select the orange "Get Form Now" button.

Step 2: So you are going to be on your document edit page. You'll be able to add, adjust, highlight, check, cross, add or delete areas or text.

Feel free to provide the following information to create the Publix PDF:

stage 1 to writing ext

Provide the necessary particulars in the Payment information from your, Total Tuition Cost, Methods of Payment, Amount of Payment, Grants andor Scholarships, Loans andor Prepaid Tuition, Cash Check Money Order andor, Reimbursement criteria To be, maintain a minimum average of, your performance evaluation, Note The entire amount of your, Social Security and Medicare taxes, and Updated area.

Completing ext step 2

Step 3: As you select the Done button, your finished file is easily exportable to all of your gadgets. Or, you might send it by means of mail.

Step 4: Be sure to create as many duplicates of your document as you can to avoid possible issues.

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