HomeMy WebLinkAbout188480 08/03/2010 a CITY OF CARMEL, INDIANA VENDOR: 359024 Page 1 of 1
ONE CIVIC SQUARE TARA POLOVICK
0 CARMEL, INDIANA 46032 CHECK AMOUNT: $188.48
14418 SIMPLICITY PKWY APT 3D
CARMEL IN 46033 CHECK NUMBER: 188480
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4128000 188.48 TUITION REIMBURSEMENT
Final Grades https: l/ banprod- ssb. ivytech. edu /pls/PROD/bwskogrd.P_ViewGrde
Final Grades C04386841 Tara E. Polovick
Spring 2010
Jul 13, 2010 02:00 pm
Student Information
Current Program
Associate of Science
y Level• Undergraduate
Program: Iidianapols Undeclared AS
Admit Term: Fall 2008
Admit Type. Transfer- Prevbus College
Catalog Tent: Fail 2006
cogeg= Ivy T-h
Campus: Indianapolis
Major: Undeclared
Major Concerdratlon: Nursing
Acadeinkstand'org: Good Standing
Undergraduate Coarse work
CRH Subject Course Section Course Tittle Campus Final Grade Attempted Earned GPA Hours Quality Points
45855 APHr 201 1 LF Advanced Human Physiology Mum C 4.000 4.000 4.000 8.00
38374 MIST 101 03A Survey of Arnencan History T Gary 8 3.000 3.000 3.000 9.00
41510 MATH 135 ON Finite Math Columbus W 3.000 0.000 0.000 0.00
41261 PHIL 173 ON American Rellgbn Columbus C 3.000 3.000 3.000 6.00
Undergraduate Summary
Attempted Earned GPA Hours Quailty Points GPA
Current Term: 13.000 10.000 10.000 23.002.300
Camalafte: 48.000 42.060 42.000 122.00 2.905
Transfer: 0.000 0.000 0.000 0.00 0.000
overaq: 4e.00 42.000 42.000 122.00 2.905
Select another Term
RELEASE: 7.3.3.1
1 of 1 7/13/2010 2:45 PM
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) ._1,41 ;A3;6
Financial Aid *
IVY TECH CC DISTANCE LEARNING
RETURNS SHIPMENTS
I�� Ill ll� ll �IIIII II�II ��Il l�ll���ll�llll��l �ll III II i illi II II Illllillllll 111 1111 IIIIIIIIII III
S708183001100105 S00370818300101076
End of Packing Document
F
2�
V n. s Logged in �s Tara R Foloya`e
V- is A N k
Y t P �VL. G tY M' M�'R Y �.p Cx•�A. J .�'Y. 4�f�� Y k k
�4'j$ 'ihT2T4thJ`��Y. YP,�H' 7 cY 3' ,S°��'J• }t t1' y ��1�` 6
�,+�..,r.ut,�'�.?� s:�vu yl�... �.ts.• =t+. w��bv�. ws��'S".� �:a .r,�a•a 4���'.w....�a'.�.+�.,. b�` �r
�Payineritsr
v.s rs�F" r *.,:k ri �.rv'i''r�?T`y� �t ;��s.
f %mac a r.,�� ��Make a Pa.yment�PaymenY�History�� ,^v a`•
.3.. f5s�"'��. t"�,3kt(,'4rFe'tY„� ,r�`a?`.�',�ga -i.�gd �e "U�s. ���a ;'n a��s�c ��"�S�t',
7 s �y
S:'�'
mx 1 ,91, t 3 5 4 9 wag s 3r* 's,t.,, 'Et 'S 1 �v1y, SSSw• ay i
a !ffi ss,. vb a" jR+ JA t 'h %emu
,P L y� ltt
3 3 e'�Ic i�kx(� i s� '.'L�'`� r k„C� t �,IG. �'"�'y��,` �F �a�a
Z t�;s�.��, �.y' IY'��X'- �r'�Y•�� z�'s4.�+�,��a� `C 3� nf ����b� '4 i:e i�v?i•'S� Ord, e�, it• xs'i
r ��.r. '.��yK�i• }rz w- C,r ,�.Y' a .,r s��.. ✓4 }b�,�.r"�iw.t' d #,',�'%..F��v�„�ar dfi�
y 9 di v '�c �h� d,�- ,>+i�+K`d' �s j ��t�'4....: 5� T i t� 5.�,,,.,{�• a cs, �r�`S� x�� �°�"I x n 4,` f z 4t
Ye'�� d�`r`�' d ��3! cs ..N ,.f� ����,,:l J ��d.��{ 7,?N-�.�,�'.d".�e �R 4 �']v�rf y�t l e Y }i.� Y'° y;3 hK �`'�•�i. 1� ��(,t
�.�i��%S':L�'3, °e i�� 14�'C[. =.i�* �r ie3�. j1.' l�j g ad r +N �F��TY.� ,{r 4�' a 4F{��?�,"�
Ivy Tech Community College of Indiana Questions, call: 317.921.4800
St'udentSchedule /Bill
Date: 12/.02/2009
Tara L. Polovick Student ID:
PO Box ;1795
Carmel; IN 46482 -1795 Term S
Due Date: '1Q -JAN- 2010
Class Schedule
w
DITS CRE F SAYS r�Ir RLI Qc
GR�{� C¢ #ISEC �UUI2SE�TITLE
38379 W11101
°01' 03A Su vey of Arnerx fi s�0 TBA TBA; [r1WW SBA
392 >96 APH3Y 20�1 DOH :Ad:varxce� Huma:n� 4 Ofl TR �2Q0 012Opm r t
4� MATH��.3.5 OA�7' Fite Nfatb 3 Ofl, TBA SA WWW TBA i
12t61?FI L17 0T Ame>MI� an Replgl3 0'00 SBA TB TBA, i
aft t CREDITS 1
f r
Currenfi:Term,Charges Current Term•PayinentslAnticipated Credits
Al In State luitzor Y' 29895 H1- Federal Unsubsidized Loan 4655 00
Al Internet Fees a 45` 00
Hl' ;Consumable_ Fees :GEN 25, 00 r
H1 In :State Tug i 398, 60 s y
r
H1.TecY�ri 1l Fee 50,` 00
J1 =In State TUltloTl 597
J1;-Int;er' Fees 90. 00
;k s tr of
.�P„ �Prm�� ta�+ce• 1 �T�T4 k
therTerrii Balance 0 0 0 Esti nd $3,14 9 55
r--
Payment m full or payment arrangements must be =made: by the end ofi 1
business on;January 102010 `After January 10, a $50 IatE fee will be
added'toyouur bill and,,you could be`:dropped,:for,non payment. °To avoid
4;non payment drop; c'ontact'your:Business °Office for, specific, deadlines.:
:To° pay -on- fine- go to -cc: vytech:edu
REMOVE. DOCUMENT ALONG THIS PERFORATION
OIvy Tech Community College of Indiana Student Name: Tara L. PoloJick
Payment .Slip Student ID: C04386841
Ivy'Tech Community College of Indiana
50 West Fall Creek Pkwy N. Dr Pay this amount: o 0-0- Amount Paid:
Indiana blis; -Check Number
S DENTS.' F! I�ANCIALAIDSTi1L3F_idTS
Finaca muse be inal
fized 2 weeks rior to the erm,startxdate�to °a
Failure to -pay may re ul in alltof the follow g actions la
1 May lie removed from, classes be+usea to satisfy account <batances
21 abil y to�rece ai eg,desltranscnptsand/or rJiplorna. ,d P g
If�you your�classe�sbefor� thwtthdraw����p
k. deadline; youmay�be responsible farthe batanceof your�charges���
If mailing payment, include this stub and send payment to the address above.
If paying by check, remember to include your Student ID
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print, Submit completed form to Department Head prior to commencement of course.)
Employee Name TO Y L QI(1 C,
Department p mtlYllGrj, p SSN Hire Date a L4 I D(p
Educational Institution* e C omill
Name of Courses C rnQYI i a 1 100 CQ 5hO, Credit] •0
n�� 1;r
,r� 0
Starting Date of Course (month/day /year) _(Yi
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 rei bursement payments is subject to federal law, which may change from time to time.
Employee Signature f 1 Dat 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 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 terrps of Section 2 -58 of Carmel. City Code.
Department Head Signature --0
Date /�-3 1
Part III (to be completed by Director of Human Resources)
Final Approval (�L 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.
05104/21 10 14:5; 9214496 IVYTECHEt PAGE 02102
Ivy Tech. Community Colleg
MEN& V
C entral Indian
Tuition /Fee Information*
ce�rraA� IWLTANA
Credi Xn State ........*OUt of Stat- e/intenlatipnal
1 ......................$99 .65....................$206.85
199 .30.....................41,.70 C
a 298 .95.....................620.55 0
4....... .....398.60.................... 827.40
5 498.25 ....................1,034.25
6 597.90....... 1,241-10
7 697.55...
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 I ,2,689,05
14 ..1,395.10.................... 2,895.90
15 ....................1,494.75 3,102.75
6 A� GA
17 ....................1,694.05 3,5 16.45
18 ....................1,'793.70 I ......3,7 3.30
*Al; s'u&;nts hill be assessed a $50.00 technology fee per semester.
All stud:,nts who enroll in an intmet based distance education course will be assessed a $1 5.00 fee per credit hour.
All s_ud!:nts on non immigrant visa status (G status exempt) will be assessed a $90.00 int ernational student fee per scmesfe
Ail perso°rs on non- imirigrant visas, including international students, will pay out-of- -state tuition.
La`vfi l p:.rrn:antnt residents, r efugees and immigrants, as well as certain other del hated statuses are i eql,:ired. to shoo+
orio nai p. c of of status.
In Tuition Eligibility
U.S. ci`izers and tiIose wh ii an immigration status of refugee asylee, indefinite par olee.. or lawfvi permanent resic=nt who
live in 171Ci,lila are eligible for in -state tuition.
Certain Aid viduals whe attended one or more Indiana Iiigi-, schools for �.t least three years and have either a) g- ad'.Jated
from an In :iar:s h4h Scf-ool orb) received a GED from an Indiana institution may be clier bic for in-slate ition rates.
Out of- -state Tuition and International Students
Non r- -_3;de its of Indiana an d a.I' individuals on noi-- immigrant visa status will be assessed o.tt -of -state tuition
71e Code+: does rot aw c in -state tuition to ndividuals with applications pending for permarent residenc
Oil visa status Must corta.ct the iriti student a dvisor at (31 7) 921 -4613 prior to
register- 'Or clzssss or ,aeting witli a pro am advisor.
VOUCHER NO. WARRANT N O.
i ALLOWED 20
Tara Polovick
IN SUM OF
13154 Dunwoody Lane
Carmel, In 46033
$188.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# 1 Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
1115 41- 280.00 $188.48 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
Friday, July 30, 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))
07/20/10 I I I $188.48
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