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Home My WebLink About193879 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 00351721 Page 1 of 1 ONE CIVIC SQUARE JAMES PAGE r. 0 i• CHECK AMOUNT: $1,560.00 CARMEL, INDIANA 46032 CHECK NUMBER: 193879 CHECK DATE: 1/19/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1202 4128000 UMS67460 1,560.00 TUITION REIMBURSEMENT 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.) r Employee Name �J Ci rMe's E PC's Department �il�Grty�c, SSN ` Hire Date 3 2 2 Did Educational Institution Name of Course ,'f'` z rUjJJS l;7 Credit Hours Starting Date of Course (month/day /year) S f By signing below, I signify that.I understand the following: 't� t �5 cd r6)Y`C+t- &eo. 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 T 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, Employee Signature '�5, Y alb Date 23 /0 Part II (to be completed by Department. Head) (Submit to Human Resources) By signing below, I certify that the applicant will have been employed frill -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 f Section 2 of Carmel City Code. Department Head Signature Dated D Part IH (to.be completed by Director of Human Resources) Final Approval 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. Martin University P.O. Box 18567 Indianapolis IN 46218 Phone: 317 -543 -3248 Fax: Statement and Schedule 01/03/2011 James E Page Student ID: 3961 N Broadway College Level: Masters Indianapolis IN 46205 Student Level: Current Schedule FA -10 Course Course Title Status Credits Grade UMS 674 50 Field Education 11 Official 3.00 A 3.00 Previous Balance $0.00 a +ah y ,ga-, %C3E� i, n,�'a',A T" "r "d s Term Date @5CfJ tJOil �d .ate s ?txe�l.�� 8.. Cr�dltSs�, m� FA -1 9/9/2010 Safety and Public Service 100.00 9/9/2010 Student Activity 3 9/9/2010 Tuition $1,560.00 9/9/2010 Computer Technology Fee --$3 00 1/3/2011 Tuition Payment Charge $1,720.00 Statement Total: $0.00 HOIdDate HoldCategory HoldDescription 03/09/2009 Bursar Office Student has an account balance. PendingTotal: $0.00 Overall Total: $0.00 Notes: Page 1 of 1 A-M el RECEIPT AMOUNT YOUR NEW YOUR OLD DATE NUMBER DESCRIPTION RECEIVED BALANCE BALANCE RECEIVED OF VE MARTI U E RSI 38245 2171 INDIANAPOLIS, INDIANA 46218 BART (317) 543 -3248 i SIGNATURE RECEIPT lo Martin University FINAL Grade Report 12115/2010 FA -10 Page 1 Page, James E Student ID: 3961 N Broadway Indianapolis IN 46205 Major Advisor URBAN MINISTRY STUDIESOliver, Claude CourselD CourseName Credits Grade GPAHours GradePoint UMS 674 60 Field Education II 3.00 A 3.00 12.00 Attempted Earned GPA Hours Grade Points GPA Comp Rate Term: 3.00 3.00 3.00 12.00 4.00 100.00 Cumulative: 69.00 132.00 69.00 261.45 3.79 191.30 NOTE. IF YOU NEED TO HAVE THE SCHOOL SEAL AFFIXED FOR LEGAL PURPOSES OR FOR TUITION REIMBURSEMENT, PLEASE BRING THE GRADE REPORT TO THE REGISTRAR'S OFFICE. f 1 L� D SAN 1 7 2011 1 By VOUCHER NO. WARRANT NO. ALLOWED 20 James Page IN SUM OF $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Carmel IS Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1202 I UMS 674 60 41- 280.00 I $1,560.00 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 Tuesday, January 18, 2011 -Direct r, IS 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)) 01/18/11 UMS 674 60 I $1,560.00 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