• • Employee Information
    • Employee information is needed for processing of benefit.  Please ensure the Employee ID is accurate.  The Employee ID is the same as the PeopleSoft ID.
  • Initial Boxes
    • These nine (9) boxes are to be initialed by the employee to document their understanding of eligibility requirements, revoking of funds and tax liability.  These boxes do not allow for electronic initials. 
  • Degree Program
    • Employee is to list the level and name of the degree they are pursuing.  If the employee is not pursuing a degree, they are to list the class titles they wish to receive the benefit for.
  • Employee Signature

This section requires a supervisor signature.  The supervisor’s signature is approving that the employee's degree program, or classes relate to the employee’s current, or prospective, duties. It is therefore, understood that the program, or classes will allow an employee to do the following:

• Prepare for technological or legal developments, or
• Increase work capabilities, or
• Increase the competence of the employee

(Only available for Fall and Spring semesters)

• If the employee requested to take classes during normal working hours, they should be listed in Section 1, C.  These classes should take no more than three (3) hours during the normal work week. 
• If a supervisor approves the request to take classes during normal work hours, they can check the box and sign on the approval option. 
• If a supervisor denies the request to take classes during normal work hours, check the box and sign on the deny option.

Note:  A supervisor may approve the degree program in Section 2, but deny the request to take classes during normal work hours in Section 3.

This section requires the department's vice president or dean signature.  The signature is affirming that the employee's degree program, or classes relate to the employee’s current, or prospective, duties. 

This section of the form is to be completed by the employee after the courses are completed.

• Certification of course completion and grade. 
• Agreement of employment continuance.

This section of the form is to be completed by the employee's supervisor prior to submitting to Business Affairs for reimbursement.

Questions regarding plan participation and eligibility should be directed to HR Benefit Services at benefits@uta.edu. 

Questions regarding the reimbursement process or student accounts should be directed to Student Financials at studentfinancials@uta.edu.