Tuition Reimbursement Taxability Questionnaire Form
Complete this form to help determine whether your tuition reimbursement should be treated as taxable income. Please answer all questions accurately. The form title is consistent across all descriptions.
Employee Full Name
*
First Name
Last Name
Employee ID or Staff Number
*
Employer Name
*
School or Educational Institution Name
*
Program or Course Title
*
Course Start and End Dates
*
Amount of Tuition Reimbursement Requested (USD)
*
Is this program or course required by your employer to maintain your current position, salary, or job status?
*
Yes
No
Does this program or course relate directly to your current job duties?
*
Yes
No
Certification: I certify that the information provided above is true and complete to the best of my knowledge.
*
I agree
Submit Questionnaire
Should be Empty: