HomeMy WebLinkAbout183821 03/29/2010 °u CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1
ONE CIVEC SQUARE DOUGLAS HANEY
CARMEL, INDIANA 46032 CIO DEPT OF LAW
CHECK AMOUNT: $4,305.84
C/O DEPT OF LAW CHECK NUMBER: 183821
CHECK DATE: 312912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4128000 4,305.84 TUITION REIMBURSEMENT
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print. Submit completed form to Department Head rp or to commencement of course.)
Employee Name poz,
Department lit m) SSN Hire Date eP a-o 7
Educational Institution* 4all &ij
F17 a W-e- 4 d 160,, dec
Name ofCourse E'v_ c.0 Cad M CS___� 1
Starting Date of Course (month/day /year) o� �G// y i&J 0 3/ 90 5.6, O
hook -s r/oo $y
By signing below, I signify that I understand the following. _r�% 3f>S• S
to i,-L_
The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -59.
To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy
of my final grade. To receive reimbursement for books, I must submit the book list for the course
and an original itemized receipt for all books purchased.
If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will
repay the City in full for its tuition and book reimbursements for this course.
The tax status of reimbursement payments is subject to federal law, which may change from time to time.
r�
Employee Signat Date 0 7— q
Part II (to be completed by Department Head)
(Submit to Human Resources)
By signing below, I certify that the applicant will have been employed full -time by the City for 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 prior to the beginning of the course. The final claim will be paid from my
department's budget, subject to the terms of Section 2 -59 of Carmel City Code.
Department Head Signature Date l Z
Part III (to be completed by Director of Human Resources)
A
Final Approval r u Date
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 or an equivalent regional accrediter.
An application will not be considered complete unless a course description from the school's literature is attached.
Rev June 07
Account Summary by Term Page 1 of 1
Anticipated third party contract payments, financial aid, and memos are NOT included in this
summary. Please Allow 24 Hours for payments to be posted to your account.
Summary
Account Balance: $3,905.00
2010 Spring Qtr 03/08 -05/30
Detail Code Description Charge Payment Balance
5CPO PhD in Public Policy Admin $4,300.00 $3,905.00
TFEE Walden Technology Fee $35.00 $0.00
DP01 PhD PPA Reduction $430.00 $0.00
Term Charges: $4,335.00
Term Credits and Payments: $430.00
Term Balance: $3,905.00
2009 Winter Qtr 12/07 -02/28
Detail Code Description Charge Payment Balance
3CPO PhD in Public Policy Admin $4,300.00 $0.00
TFEE Walden Technology Fee $35.00 $0.00
DP01 PhD PPA Reduction $430.00 $0.00
DPP1 PhD Pub Policy Admin Reduction $0.00 $0.00
PLCK Cash Receipt $3,905.00 $0.00
Term Charges: $4,335.00
Term Credits and Payments: $4,335.00
Term Balance: $0.00
2009 Fall Qtr 09/08 -11/30
Detail Code Description Charge Payment Balance
1CP0 PhD in Public Policy Admin $2,580.00 $0.00
1CPP PhD Public Policy Admin $0.00 $0.00
TFEE Walden Technology Fee $35.00 $0.00
DP01 PhD PPA Reduction $258.00 $0.00
DPP1 PhD Pub Policy Admin Reduction $0.00 $0.00
PLCK Cash Receipt $2,357.00 $0.00
Term Charges: $2,615.00
Term Credits and Payments: $2,615.00
Term Balance: $0.00
Account Balance: $3,905.00
https:// ssb. watdenu. edu /pls /PROD/bwskoacc.P_VlcwAcct 31512010
Final Grades Page 1 of 1
Student Information
Current Program
Doctor of Philosophy
Level: Doctorate Quarter
Program: Doctor of Philosophy PPA
Admit Term: 2009 Fall Qtr 09/08 -11130
Admit Type: Deferred to a New Term
Catalog Term: 2009 Fall Qtr 09/08-11130
College: College of Social and Behv Sci
Campus: Walden
Major and Department: Public Policy and Administrat, Pub Policy and Administration
Major Concentration: Law and Public Policy
Academic Standing:
Doctorate Quarter Course work
CRN Subject Course Section Course Title Campus Final Attempted Earned GPA Quality
Grade Hours Points
13244 PPPA 8431 1 Finance Budgt for Pub Walden A 5.000 5.000 5.000 20.00
Sec
13448 PPPA 8810 1 Fund of Law Pub Pol Walden A 5.000 5-000 5.000' 20.00
Doctorate Quarter Summary
Attempted Earned GPA Hours Quality Points GPA
Current Term: 10.000 10.000 10.000 40.00 4.00
Cumulative: 16.000 16.000 16.000 64.00 4.00
Transfer: 0.000 0.000 0.000 0.00 0.00
Overall: 16.000 16.000 16.000 64.00 4.00
Select another Term
https: /ssb.waldenu.edu /pls /PROD /bwskogrd. P_V lewGrde 3/5/2010
Walden University Online Online Bookstore: May Account My Order History Page 1 of 1
1
WALDEN UNIVERSITY
A. hr' her degree. A higherpurpose.
Home My Account Help Contact Us Log Out CHATLIVENOW
My Account: My Order History and Status
Order Number: 10712584
Tracking Number: IZSX097XO334699117
Shipment Type: UPS Ground
Subtotal: 379.70
Shipping: 11.14
Grand Total: 390.84
Order Date: 11/10/2009
Order Status: Complete, On Backorder 1
i r
Author Title Type Qty Price
Carter, Christine B. Administrative Law and Politics: Cases and Comments Paperback 1 $96.00
American
Psychological Concise Rules of APA Style -2009 Edition Spiral 1 $28.95
Association
Mikesell, John Fiscal Administration Hardback 1 $199.50
Walden University Mmpa 6431: Finance and Budgeting.. Public -DVD DVD 1 $10.00
Walden University Mmpa 6810: Fund. of Law and Public Policy -DVD DVD 1 $10.00
Kerwin, Cornelius Rulemaking How Government Agencies Write Law and Make Policy Paperback 1 $35.25
M.
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Walden University Online Online Bookstore: My Account My Order History Page 1 of I
ALLEN UNIVERSIT I
A higher degree. A higher purpose.
Home My Account Heip Contact Us Log Out
My Account My Order History and Status
Order Number: 10712584
Tracking Number: 1ZSX097XO3347 83472
Shipment Type: UPS Ground
Subtotal: 10.00
Shipping: 0.00
Grand Total: 10.00
Order Date: 11/12/2009
Order Status: Backorder Complete
M I
Author Title Type Qty Price
Walden University Mmpa 6810: Fund. of Law and Public Policy -DVD DVD 1 $10.00
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Your Textbooks Partner
https: bookstore .mbsdirect.net /vb_account.php ?ACTION= orderdetalI &ord= NJwN51 VnXE... 31512010
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
Douglas C. Haney
Purchase Order No.
Terms
Carmel, Indiana 46033
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 15 10 Reimburse Douglas C. Haney for monies he personally
expended to attend Walden University's on -line courses,
"Finance and Budgeting for the Public Sector" an
Fundamentals of aw and Public Police'
per the attached receipts and forms
Total Q
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited sam��I�C' c &Unce
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Douglas C. Haney IN SUM OF
Carmel, Indiana 46033
t
$4,305.84
e
ON ACCOUNT OF APPROPRIATION FOR
DEPARTMENT OF LAW 1180
410 -28000 Tuition Reimbursement
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1180 14,305.84 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
t� S 20 (7
nture
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund