Tuition Reimbursement Refusal Form
Document the reasons and details for denying an employee’s tuition reimbursement request.
Employee Full Name
*
First Name
Last Name
Employee Department
*
Please Select
Human Resources
Finance
Operations
Sales
Marketing
IT
Customer Service
Other
Date of Reimbursement Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Course or Program Name
*
Institution Name
*
Amount Requested (USD)
*
Reason for Refusal
*
Incomplete documentation
Request submitted after deadline
Course not eligible under policy
Exceeded annual reimbursement limit
Employee not eligible
Other
Additional Explanation (if needed)
Refusal Decision Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewed By (Name or Title)
*
Submit
Should be Empty: