186473 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 359024 Page 1 of 1
t ONE CIVIC SQUARE TARA POLOVICK CHECK AMOUNT: $753.75
CARMEL, INDIANA 46032 P 0 BOX 1795
CARMEL IN 46082 -1795 CHECK NUMBER: 186473
o
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4128000 753.75 TUITION REIMBURSEMENT
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Fin Grades C04386841 Tara L. Polovick
Spring 2010
May 30, 2010 08:03 pm
Student Information
Current Program
Associate of Science
Level: Undergraduate
Program: Indianapolis Undeclared AS
Admit Term: Fall 2008
Admit Type: Transfer- Previous College
Catalog Term: Fall 2008
College: Ivy Tech
Campus: Indianapolis
Major: Undeclared
Major Concentration: Nursing
Academic Standing: Good Standing
Undergraduate Course work
CRN Subject Course Section Course Title Campus Final Attempted Earned GPA Quality
Grade Hours Points
45855 APHY 201 11F Advanced Muncie C 4.000 4.000 4.000 8.00
Human
Physiology
38379 HIST 101 03A Survey of Gary B 3.000 3.000 3.000 9.00
American
History I
41510 MATH 135 QAJ Finite Math Columbus W 3.000 0.000 0.000 0.00
41261 PHIL 173 0A1 American Columbus I 3.000 0.000 0.000 0.00
Religion
j
i Undergraduate Summary
Attempted Earned GPA Hours Quality Points GPA
Current Term: 13.000 7.000 7.000 17.00 2.429
Cumulative: 48.000 39.000 39.000 116.00 2.974
Transfer: 0.000 0.000 0.000 0.00 0.000
Overall: 48.000 39.000 39.000 116.00 2.974
Select another Term
i
RELEASE: 7.3.3.1
http: /cc. vytech. edu /cp /render.UserLayoutRootNode. uP ?uP_tparam= utf &utf= http %3 A %2... 5/30 /2010
Packing Slip Page: 2
Store: 1076 IVY TECH CC DISTANCE LEARNING
Order Information Shipping Information
Web Number: 10760000093148 Shipping Method: FEXGRD
SODA Number: 3708183 -001
Customer Name: Tara Polovick Shipping Address:
Order Date: 01/04/2010 12:01 PM Tara Polovick
Last Updated: 01/05/2010 07:03 PM 13154 Dunwoody Ln
Carmel, IN 46033 USA
Home Phone: (716) 870 -3608
Customer Email: tarapolovick @gmail.c
om
Substitute Preference: Yes Please substitute.
Avail. Unit Total
Product SKU Date Qty Price Price
American People Concise VI Pkg <New> 9780558221218 01/09/10 1 61.50 61.50
Ivy Tech CC
Gary Campus >HIST >101 >03A
Anp 201 Lecture Laboratory S <New> 9781427538345 01/09/10 1 24.00 24.00
upplement
Lawrence Campus >APHY >201 >DOH
Finite Mathematics 9780321428295 01/09/10 1 .00 .00 Backordr
Columbus Campus >MATH >135 >OAJ
American Religious Traditions <New> 9780800636166 01/09/10 1 39.00 39.00
(w /CD)
Columbus Campus >PHIL>173 >0AJ
Subtotal: 124.50
Tax: 9.26
Shipping: 7.67
Order Total (USD) 14-1-:143'-"A
Financial Aid *
IVY TECH CC DISTANCE LEARNING
RETURNS SHIPMENTS
11111111111111111111111111111111111111111111 1 lull 1
S708183001100105 S00370818300101076
End of Packing Document
Packing Slip Page: 2
Store:'1076 IVY TECH CC DISTANCE LEARNING
Order Information Shipping Information
Web Number: 10760000098326 Shipping Method: FEXGRD
SODA Number: 3765185 -001
Customer Name: Tara Polovick Shipping Address:
Order Date: 01/07/2010. 11:46 AM Tara Polovick
Last Updated: 01/08/2010 07:25 PM 13154 Dunwoody Ln
Carmel, IN 46033 USA
Home Phone: (716) 870 -3608
Customer Email: tarapolovick @gmail.c
om
Substitute Preference: Yes Please substitute.
Avail. Unit Total
Product SKU Date Qty Price Price
Human Physiology (w /10 -Syst Su <New> 9780321559395 01/12/10 1 194.00 194.00
ite CD)
Muncie Campus >APHY >201 >11F
Subtotal: 194.00
Tax: 14.56
Shipping: 13.95
Order Total (USD): __222_.51
Financial Aid *
IVY TECH CC DISTANCE LEARNING
RETURNS SHIPMENTS
11I4�I�l�llllllilllllllllllllil111111111111111111111 III IIIIIIIIIIIIIIIIIIIIII lIIIIllllllllllllllllll!
5765185001100108 S00376518500101076
End of Packing Document
Ivy Tech Community College of Indiana Questions, call: 317.921.4800
Student Schedule /Bill
Date: 12/02/2009
T ara _L. PolovicK Student ID:
PO 66x,1795
Carmel IN -46082 -1.795 Term kSpr ng; 2 0'T1
Due Date 10 =JAN -2010
Class Schedule
ci��,: ;covRSE,�sEC CovRS� =TIm�, cu>rbrrs�:� ��xs �r>w>~ a.nc�oom
383 9 gH� S'�10 03'4 Sine cif Amery 30'Q' TBA TBA WWT�T SBA
s
3.9295 kAP.HY 2 %1, O dvancec3 =Human 4 �t00 °TR 1 (l:0 0�12 1FAWfE'8 .F22Q�5 .t
41,0 t�7ATH�1 UfAi7 �zn t.cMat 3fl 0 TBA TBI 4 WWW TBA
TOTAL CREDITS 13 0
Current.Term -CLiftent Term -Pay inentslAnticlpated'Credits
Al Tn State•.Tuition 248 95� H1- ederaa Unsubs "zed Loan 4655 00
A1- ,rnt'i Yrh6t F,ee f xt a 4500,
w
H1 Consumable; FeesiGEN 25 00
Hl -In St ate TiHtaon far 398 60 r i
H1 :Technology Fee a 50: 00 k
J1 In State Tip tion 597` 90
0
JI,Internet Fee x r r
90, 0
r(
�f
7 y3 4
C
may
ether Te rm Ba anee 0 Q Q EsttmateclRefund $3,14955 4
nt m full or payment afrangements must be made by the<end of
tiPayme
business on January. 10, •2010. After January-A0, ,a $50 late.fee be
added. .Our;bill,and you could be dropped:for., :non payment �To avold-
non- payment~drop,,tontact Bus iness:Office for specific deadlines~
To pay an -line go #o: ccfvytech edu
REMOVE DOCUMENT ALONG THIS PERFORATION
Ivy Tech Community College of Indiana Student Name: Tara L. Polovick
Fa" menf Sli Studenf ID:
Ivy Tech Community College of Indiana Pay this amount: ti 0 0 1 Amount Paid:
50 West Fall Creek Pkwy N. Dr
Indianapolis, IN 46208 -Check—Number:-
STUDENTS FINAMAAL AID STUDENTS
Fall eft a ma result Ingal of =the foilowin actloris Fln clal Ald must be�nallzed 2 weer ES nor to the term st rt date,fa
9. p
1 Mayde removed f►omclass he used to�satis�fy accou�n#ba3anc`es:
Z;K 2 Inability lob receive gradesltranscnpts and /a,d�plama,- y h Pq w
y R Ito Iihtlraw fom lof your classe' "sbefo ethe�sw „drawal -i
deadhneyoumay be•responslble:forthebalance of your charges
a ft xl
If mailing payment, include this stub and send payment to the address above.
If paying by check, remember to include your Student !D
Ika4�MR(
G i=N GA,L INT S w
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05/04/21110 14:5, 9214496 IVYTECHt PAGE 02/02
Ivy Tech Community C ollegt
W o Central Iii
[MIN
Tuition /Fee I
Cfrf[AAL +Nr11ANA
Credits In State ........*Out of Statc/TnteTj.atjonat
1 ......................$99 ,65....................$206.85
2... ...................199 .30.....................413.70
3 .298.95 620.55
4....... .....398.60.................... 827.40
5 ......................498.25 ....................1,034.25
6 597.90................... 1,241.10
7 597. 55 ....................1.,447.95
8 797.20 ...................1,654.80
9 896.85.... 1,861.65
10 996,50 ....................2, 068.50
11 ....................1,096.15 2,275.35
12 1,195.80.................... 2,482.20
13 1,295.45 ........2,589.05
14 1,395.10 2,895.90
15 ....................1,494.75 ....................3,102.75
1
Ld ....................1,59 .4.0 3 ,3 -0 G�
17 ....................1, 694.45 .................3, 516.45
18 ....................1,793.70 3,723.30
'r Al i sud .nts will be assessed a $50.00 technology fee per semester.
All stud:.-Tits who enroll in a-t iii tern et- based distance education course will be assessed a $15.00 fee per credit hour.
4 All stud!.mts oil non immigrant visa status (G status exempt) will be assessed a $90.00 international stidert fec per scrneste
All persons on non iminiarant 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 prc of of status.
Di' Tlitiar1 Xligib Ili ty
U.S. citizer s aad those with an immigration status of refugee as dee, indefinite parolee, or lawful permanent resident who
live in Indi;ina are eligible for in -state tuition.
Certain ind viduals who attended one or more Indiana higi. schools for at least three years and have eitlter a) graduated
from an Indiana higl7 School or b) received a CED from an lndiana institution may be eligible for in -state tuition rates.
Out cif -state Tuition and International Students
Non- reslr]esAS of Indiana and all individuals cn non- ismrnigrant visa status will be assessed out -of -state tuition Mte5•
The Colleg:: does not award in tuition to individuals with applications pending for permanent residence.
Persons on ion- immigrant visa status must contact th.e i„tcrinational student advisor at (3) 7) 921-46113 prior to
registering 'or classes or meeting with a program advisor.
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print. Submit completed form to Department Head pdar to commencement of course.)
Employee Name i l Oy1 L
Department ,p Mim I i C.b, n S
SSN Hire Date
Educational Institution* e
Name of Course 1' M 50 Credit Hours •c7
MOA, kyyl
Starting Date of Course (month/day /year) t' p
(7
By signing below, I signify that I understand the following:
The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 58.
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 an original itemized receipt
or other proof of purchase that links 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 in full for its tuition and book reimbursements for this course.
The tax status of reirrlbursement payments is subject to federal law, which may change from time to time.
Employee Signature Date 29-
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 Ieast 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 temps of Section 2 -58 of Carmel City Code.
Department Head Signature
Date
Part III (to be completed by Director of Human Resources)
Final Approval 5 ti,. 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 accreditor.
An application, will not be considered complete unless a course description from the school's literature is attached.
VOUCHER NO. -WARRANT NO.
ALLOWED 20
ara Polovick
IN SUM OF
13154 Dunwoody Lane
Carmel, In 46033
j$o3-55
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 41- 280.00 3.58 1 hereby certify that the attached invoice(s), or
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
Monday, June 07, 2010
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/04/10 I I -T $803.58
1 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
Clerk- Treasurer