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Home My WebLink About258808 05/26/16 yo�. q� CITY OF CARMEL, INDIANA VENDOR: 365721 1z ® ONE CIVIC SQUARE MIKE DELONG CHECK AMOUNT: $'****1,007.11' 49` /+' CARMEL, INDIANA 46032 C10 CFD CHECK NUMBER: 258808 ''�rroN�' CHECK DATE: 05/26/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4128000 032216 1,007.11 TUITION REIMBURSEMENT VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED 20 MIKE DELONG ACCOUNTS PAYABLE VOUCHER C/O CFD IN SUM of$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $1,007.11 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 0 41-280.00 $1,007.11 1 hereby certify that the attached invoice(s),or 5/17/16 0 $1,007.11 1120 032, 42101 1120 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Wednesday, May 18,2016 David Haboush Fire Chief I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20- Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Delong Tuition Reimbursement Class Credit Hours Cost per Credit Hour Total NRSG 206 4 $ 133.15 $ 532.60 NRSG 207 2 $ 133.15 $ 266.30 Book $ 274.99 Technology Fee-Every Semester $ 60.00 Nursing Program Fee- Every Semester $ 125.00 TOTAL CLASS COST $ 1,258.89 Allowed Reimbursement 80% TOTAL TO BE REIMBURSED $ 1,007.11 City Of.Carmel, Tuition Reimbursement.Application Form Part I(to'be completed by employee) (Please print:. Subtriif.com.pleted,`form to Department Head_ rip or to,cominencement:of course:) Employee Name Michael D`eLong Flre 03/06/1:999 Department SSN - Hire Date Educational Instltution* Ivy Tech Community Colfego Name of Course** N RSG 206 Credit Hours.4 Starting Date:ofCourse(month/d"ay%year) 0 1I. I2016 By signing below,I signify:that I understand the following: The tuition reimbursemerit.prograuh is subject to'the.terms of-Carmel City Code, Sectioh2-58 To receive reimbursement for tuition;,I must.subrnit evidence.of payment for the.-course and a copy of my,fnal grade. Tdxeceiv..e reimbursement for books,1-must submit.an original itemized receipt or other proof of purchase-that links,these books to this.par cular course. Lf.I leave City_of Carmel employment goner than one,(.1) year afterthe;end:of thiscourse;,. will repay ahe City to full.for its tuition,and book reiinbt.irsementsifor this:course.. • The tax:status:ofreirribursement ay ents.is subject federal law,which-may change from timeao time. Employee:Signature Date 1,2IO4I20 5 Part II(to be completed.by I)epartmen#Head) (Submit to.Huinan Resources) By signing below, I certify, that the applicant will have been employed full=time by't1e:CityTor:at least one.(1) year prior'to:the commencement.of the course, and has not been,subject to;a disciplinary probation,.suspension or demotion within 90` days pri` r to the beginning,of the course. The .final claim :will be pai&from my departmerWs'budget,subject to t_e tern of ection 2-5 of Carm 1 City Code; (� Degartment.Head.Sighature t 'Date Part lII(to be completed byDirector of Human..Resources) Final Approval " ` Date If denied,reason,for denial` * The tuitionireiriibursement,program covers"only full-semester courses offered through a degree-granting'institution. accredited by th North.Central Association of Colleges and Schools or an equivalent.regional accreditor.. ** An application will not be considered complete unless a course description from the school's.1herature is attached: City Of Carmel Tuition Reimbursement,Application-Form Partf.f(to be.compteted.by employee) {Please pr'lnt. :Siibrhit conipleted'form:to Department Head' ti'`t to epniitiencement of course:} OpplpyeeName Michael-:D.eLon.g :Department Fite ssN 306-$Q 9354 1liie Date.03/Q6/1 99.9 Educational Institution* IVy Tech CommUnity C011ege 'Name ofC... ** NRSG 297 Credit Hours Starting'Date of Course(month/day/year)' '01/1112016 $y signing-below,.i signify thatI understand the following: • The-tuifion,reirnburserrient program is sUJect•to`the terms of'Carmel.CityCode, Sectidn'168:. To receive reimbursement for.tuition,I.must stibn !evidence of paymentfor the course and a copy of'MY final grade.. To receive.teimbursement for books,I must submit:an.original itemized.receipt or other;proof,of purchase-that-inks these books to"this particular course. If I leave City .of Carmel employment sooner-than one (1) year after the end of this course,I will repay the City iti full for its tuition and book:reitnburkin,--s,for this course: • The tax status:of reeiimmbbursem t p ments is subject to federal-law,which may change from-timeto.time: Employee:Sgnatura% r Date 1_2/04/2015 Part IT(to;be°completed by'Department Head) (Submit to'Human_Resources) By signing below;I certify~that the.applicant will have aeememploye&fnll�time by the City.for at least one(l) ,year•pi'lor fo the:commenceinent of the course,and has not been subject to a disciplinary probation,suspension: or demotion�.withn 90 days prio" to the begintlin of the course: The final claim will be paid from,my department's budget,subject to th t rms f ecki n -58 o arinel City Code, y� Department Head Signature Date Part III (to be completed by Director:ofHutman Resources) Final Approval l` - l i � �'��` '` Dated 7 1 if denied',reason for denial * The tuition reimbursement program covers only full-semester courses offered through a degree-granting,.institution. accredited by the North Central Association of Colleges and Schools ran an equivalent regional accreditor. ** An application will not be considered complete unless a course description from the school's literature is attached. TVITION/FEE INFORMATION Credits . . . . . . . . . . . . . . . . In State . . . . . .*Out of State/International 1 . . . . . . . . . . . . . . . . . . . . .$133.15 . . . . . . . . . . . . . . . . . . . . $262.40 " 2 . . . . . . . . . . . . . . . . . . . . . . 266.30 . . . . . . . . . . . . . . . . . . . . . 524.80 ` 3 . . . . . . . . . . . . . . . . . . . . . . 399.45 . . . . . . . . . . . . . . . . . . . . . 787.20 4 . . . . . . . . . . . . . . . . . . . . . . 532.60 . . . . . . . . . . . . . . . . . . . .1,049.60 . 5 . . . . . . . . . . . . . . . . . . . . . . 665.75 . . . . . . . . . . . . . . . . . . .1,312.00 6 . . . . . . . . . . . . . . . . . . . . . . 798.90 . . . . . . . . . . . . . . . . . . . 1,574.40 7 . . . . . . . . . . . . . . . . . . . . . . 932.05 . . . . . . . . . . . . . . . . . . . .1,836.80 8 . . . . . . . . . . . . . . . . . . . . 1,065.20 . . . . . . . . . . . . . . . . . . . .2,099.20 9 . . . . . . . . . . . . . . . . . . . . .1 198.35. . . . . . . . . . . . . . . . . . . . 2361.60 r' 10 . . . . . . . . . . . . . . . . . . . .1,331.50 . . . . . . . . . . . . . . . . . . . .2,624.00 .. 11 . . . . . . . . . . . . . . . . . . . .1,464.65 . . . . . . . . . . . . . . . . . . . .2,886.40 �y 12 . . . . . . . . . . . . . . . . . . . 1,597.80. . . . . . . . . . . . . . . . . . . . 3,148.80 13 . . . . . . . . . . . . . . . . . . . .1,730.95 . . . . . . . . . . . . . . . . . . . .3,411.20 t 14 . . . . . . . . . . . . . . . . . . . .1,864.10. . . . . . . . . . . . . . . . . . . . 3,673.60 �. 15 . . . . . . . . . . . . . . . . . . . .1,997.25 . . . . . . . . . . . . . . . . . . . .3,936.00 Rates Effective for Fall 2015, Spring and Summer 2016 4 Tuition Rates per Cre it Hour $ y In-State In-State Out-of-State Out-of-State DE '10I As", VA/IN discount Fall 2015 $ 133.15 $ 111.15 $ 262.40 $ 156.50 v Spring 2016 $ 133.15 $ 111.15 $262.40 $ 156.50 Summer 2016 $ 133.15 $ 111.15 $262.40 $ 156.50 **All students will be assessed a$60.00 technology fee per semester. **All students who enroll in an intemet-based distance education course will be assessed a$20.00 fee per credit hour. **All students on non-immigrant visa status(G status exempt)will be assessed a$90.00 international student fee per semester. **All students who are enrolled in either Nursing and Practical Nursing will be assessed a$125.00 fee per semester and Dental Hygiene will be assessed a$62.50 fee per semester. * All persons on non-immigrant visas,including international students,will pay out-of-state tuition. * Lawful permanent residents,refugees,and immigrants,as well as certain other designated statuses are required to show original proof of status. In-state Tuition Eligibility U.S. citizens and those with an immigration status of refugee asylee, indefinite parolee,or lawful permanent resident who live in Indiana are eligible for in-state tuition. Out-of-state Tuition and International Students Non-residents of Indiana and all individuals on non-immigrant visa status will be assessed out-of-state tuition rates. The College does not award in-state tuition to individuals with applications pending for permanent residence. Persons on"Fl"visa status must contact the international student advisor at(317)921-4613 prior to registering for classes or meeting with a program advisor. For more information about current and future tuition and fee rates please visit: ivytech.edu/tuition Updated 7-1-2015 UMM Ivy Tech Community College of Indiana 50 West Fall Creek Pkwy N. Indianapolis, IN 46208 Michael DeLong Date: 03/22/2016 12153 Belfry Dr Noblesville, IN 46060-6079 Student ID: C05192874 Term: Spring 2016 (201530) Due Date: 22-MAR-2016 Current Term Balance: $0 . 00 AMOUNT DUE: $0 .00 Previous Term Balance: $0 . 00 PAST DUE AMOUNT: $.00 Future Balance: $0 . 00 Student Schedule and Bill CRN COURSE WSEC COURSE TITLE CREDITS DAYS TIME BLDG/ROOM 33694 NRSG 206 CIH NRSG Care of Ch 4.00 T 1100-1150am LAWFB F211 1200-0350pm F215 33696 NRSG 207 C1H NRSG Care of Ch 2.00 MF 0630-0600pm LAWFB NOROOM '4838-:' NRSGG12 W GIHH - -3: a94— CREDITS: 9.00 CURRENT TERM CHARGES CURRENT TERM PAYMENTS CHARGES =_____________ ____= CREDITS/ANTICIPATED CREDITS H1-Book Charges 339. 75 Direct Fed Unsubsidized Loan 3958 . 00 H1-Book/Suppgy Chgs Tax 23. 78 H1-Finish Line Grant 375. 00 H1-In State Tuition 1000 . 35 H1-Visa/MC Payment-fb 5. 00 H1-Nurse Program Fee 125. 00 Hl-Student Identification Card 5. 00 H1-Technology Fee 60 . 00 Refund 2784 . 12 Total Current Term Charges: $4,338.00 Total Current Term Credits: $4,338.00 Campus Connect- Ivy Tech Community College Page 1 of 1 campus connect �� Back to Q%' a •� Home Tab search facebook twitter bb 9.1 Gmail Groups Logout Help n oil C05192874 Michael DeLong Spring 2016 Ivy Tech Community College - Official May 16, 2016 08:50 am Grades ; i i Student Information Current Program Associate of Science Level: Undergraduate Program: Indianapolis Nursing AS Admit Term: Fall 2015 s.; Admit Type: Continuing New Degree Catalog Term: Fall 2015 College: Ivy Tech Campus: Indianapolis s•; Major: Nursing .; Major Concentration: Nursing Paramedic to AN Academic Standing: Good Standing ? � i Undergraduate Course work i CRN Subject Course Section Course Title Campus Final Attempted Earned Grade GPA Quality Hours Points 4 48371 NRSG 126 C1H Mental Health Indianapolis- B s Nursing Lawrence 2.000 2.000 2.000 6.00 i � 48387 NRSG 127 CSH Mental Health Indianapolis- A Nrsg Clinical Lawrence 1.000 1.000 1.000 4.00 33694 NRSG 206 C1H NRSG Care of Indianapolis- B Childbearing Lawrence 4.000 4.000 4.000 12.00 Fa m � i 33696 NRSG 207 CIH NRSG Care of Indianapolis- A Childbearing Lawrence 2.000 2.000 2.000 8.00 Clin Undergraduate Summary Attempted Earned GPA Hours Quality Points GPA Current Term: 9.000 9.000 9.000 30.00 3.333 Cumulative: 34.000 34.000 34.000 122.00 3.588 Transfer: 55.000 55.000 0.000 0.00 0.000 Overall: v http://cc.ivytech.edu/cp/render.UserLayoutRootNode.uP?uP tparam=utf&utf=http%3A%2... 5/16/2016 .........................................� GIVING YOU MORE TEXTBOOK CHOICES NEW-USED-RENTAL-DIGITAL ......:..:............................... SIGN UP FOR NEWS & DEALS AT efollett.com/welcome ....:.:...........0..0............0....0. RENT -NOW -- - SAVE -NOW- - RENTING BOOKS SAVES MONEY ......................................... WE BUY BACK TEXTBOOKS EVERY DAY See store for details G•rC:'::.:':r..•.u.a....:a,...0........0.8% GIVING YOU MORE TEXTBOOK CHOICES NEW-USED-RENTAL-DIGITAL ..........•0.......................i....• SIGN UP FOR NEWS & DEALS AT efollett.com/welcome •....ii•...............i'.............G..• R E WN O LAWRENCE CAMPUS BKS FAIRBANKS CTR FOR HEALTH PROF 9301 E 59TH STREET 317-921-4693 www,ivytechshop.com 1067mgrCfheg.follett.com ITEM QTY PRICE TOTAL ---- --- ----- ----- New Maternal & Child Hlth Nsg (Cou 016105991 1 $257.00 $257.00T New -Pq--A $ Z-75:F Sur )otal `asq_ -439-.-75 Tax Total House Charge: Major Acct: 201530 Student ID: C05192874 Signature X. . .. . .. .. . .. . . .. . . . .. ... .. .. . DELONG, MICHAEL SPRING 2016 STU�'ENT FIN',N+CIAL AID IN 7.0 C, 7,0000 23.78 AMOUNTS UNPAID BY YtC'I ,'R SPONSOR OR FUNDING PROVIDER WILL BE YOUR FINANCIAL RESPONSIBILITY. Items Purchased: 2 . Items Returned: 0- I!IIII IIII I Ilii ii'lliill! '1'�l��li!I f!!I!Illli{i�l�Idll!NII!I!II IIII * X78544042704 , Associate:Kim Text returns seven days from t of class. .red for returns. tii