Tuition Reimbursement Plan (TRP)
Non-Harvard Course Reimbursement
Non Union
Section I: Employee Information
Last Name:
First Name:
Harvard Identification Number (HUID):
Work Telephone:
Home Telephone:
Mobile Telephone:
Email Address:
Address Line 1: Home Mailing Both
Address Line 2:
Address Line 3:
City, State, Zip:
Section II: Course Information
Semester:
Credit Type:
School/Program:
Credit Hours:
Course Title:
Course Number:
Course Start Date (mm/dd/yyyy):
Course End Date (mm/dd/yyyy):
Course Cost (Tuition Only):
Reason for Taking Course:
Grade: * If you do not have your grade at the time of submission, it must be supplied within 60 days of the last day of class.
Section III: Course Documentation
Upload Proof of Payment: (Receipt from school) * Required for submission

Upload Proof of Cost: (Itemized bill from school) * Required for submission

Upload Grade(s)/Proof of Course Completion:
Section IV: Approval Information (Only one signature is required)
Immediate Supervisor Name:
Date:
Immediate Supervisor's Signature:
Human Resource Contact Name:
Date:
Human Resource Contact Signature:
Section V: Employee Confirmation
I have thoroughly read and agree to all terms and conditions outlined in the Harvard University Tuition Program Policy. I both acknowledge and agree my digital signature below represents my compliance with the terms and conditions outlined in said policies.
Staff Member Name:
 
IMPORTANT: After pressing the SUBMIT button, there will be a link which you must click on to view your completed application. This will be the only opportunity you have to print the form for the required signatures. Once ALL required signatures have been obtained, please follow the instructions in step 3 on the landing page to finalize your claim.