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Home My WebLink About177347 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 00351721 Page 1 of 1 ONE CIVIC SQUARE JAMES PAGE CHECK AMOUNT: $4,840.00 CARMEL, INDIANA 46032 CHECK NUMBER: 177347 CHECK DATE: 9/15/2009 DEPARTMENT ACC PO NUMBER INVOICE NUM AMOUNT DESCRIPTION 1202 4128000 REIMB 4,840.00 TUITION REIMBURSEMENT City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed Form to Department Head pnur io commencement oFcourse.) 19 Employee Fame Department Tall P1.__,N12 4:h'o 2 S ys��{yjc, SS` � Educational institution;` 444- e .f Jam' 1 1 S r Name of Course Startin'u Date of Course (month day "Fear) By si'unin'u below. si'7nif� that I understand the !ullowinU: The tuition reimbursement program is subject to the terms of Carmel Lit,, Code, Section To receive reimbursement For tuition. must submit c ideilce of Pa,ment for the course anci a copy of my final 'Trade. To receive reimbursement for books. l must submit the book list for th° course and an onuinal itemized receipt for all books purchased. If 1 lease C't of l- drnnel employment sooner hall one I year inter the end of his course. .iii] repay the City in hull for its tuition and book reimbursements Fur ;his course. Tile inx st2uus Or reimbursement pay m .nis is sub)ei;i 0 ieaeral :aw. whic n1a`•' c,ia.nge from me to .:m C. Date Part 11 (to be completed bN Department Head) l Submi[ :o Human Rifsources l siLrrling i, I CU it`.' that the applicant will ha %e '")ee 1 ��Tp e' !Ui nmz) he C ;T':' IUr 1i it Si .:r:': Fear orior io the commencement of the course. and has not been _L1bleC( (0 :1 d c:vlinar'_.' t)rooaiion. s 1 i'U 1 iUIi or demotion within l 90 days pr :0 tl bed'.nn1P." 'J( the coU, i ;le ilnal c'.alm `.'`'ill Je ,aaid :rom (11` �IeCanille n[ bUC1'uei. SUbIZCi :o (he ierril oI S 'on 2 _9 of Larmti D'eJlrmen[ Head JI'_T?la[lire /J v Date Part III (to be completed by Director of Human Resources) v al Date :nai Appro e,�, 1 0 1. .nieti. reason tor '�eniai ;lie alinon reinlbursemeni Drour:im :Lwers only :0LIrSCS viiereU [1lroll_L'h a lie'dre -`NZIMIP.!L li1sil(IIt1011 acc^ dited by the `:or'h ASsociariun of colle_!es .1n 1 Schools or an _gtw.'alen[ regional accr,-diior. :1n aDDIiCa[10i1 ��III 'lot Le considered CMI Iplete unl ess a .:l)Urse desc ,Pion Irom the school s literaitlr: IS atiached. City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head np or to commencement of course.) Employee Name G Department 1Kn46LC'A2 5 X5��iS Educational Institution* /AZt'/y \tame ofCourse Starting Date of (month,`davivear) By si-7tain? below. I s1--nifv that I understand the followin2l: The tuition reimbursement program is subject to the terms of Carmel Cite Code.. Section 2 -59. To receive reimbursement for tuition. I must submit evidence of payment for the course and a coot' of my final Jrade. To receive reimbursement for books. 1 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 t l) year after the end of this course. 1 Will repay the City in full for its tuition and book reimbursements for this course. The tax status or reimbursement payments is subject to federal !aw. which may change from time to time. Employee Signature Q Date 11 2 Part II (to be completed by Department Head) (Submit to Human Resources) By si1m1n below. I certifv that the applicant will have been emioved Lull -time by the Ciry for at ieast one 1 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 wiil be paid :rom mV departments bud`Tet. subject to the terms of Section 2 -59 of Carne! l: ir.' Code. Department Head Sigmature Date Part III (to be completed by Director of Human Resources) Final approval Date D [l'denied. reason for denial The tuition reimbursement program corers onl% gull- semester courses offered 1111'ou2h a ie_ree rantin_ institution accredited by the North Cenrral association of Colle,_es and schools or an equivalent regional accreditor. an application ill not be considered complete unless a course description from the schools literature is auached. City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head rip or to commencement of course.) Employee Name Departmen ll Educational Institution* 4��P�> IJ�Li' /7/��/ Name of Course S7`O�/`Gt� C GtI`e T5 5 a L Starting Date of Course (month/day /year) 0 By signing below, I signify that I understand the following: The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2-59. 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. Employee Signature A r Date -2 4 1" 0 3� 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 Part III (to be completed by Director of Human Resources) Final Approval �G�^ Date /a'� 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 schools literature is attached. P g n J y y W DATE �7 A T ORI SUB rJ l TOTAL y F c REFERENCE NO. SERVER TAX ID- FOLIO/CHECK NOJLIC. NO. STATE REGJDEPi. CLERK TIP MISC. ;SIGN HERE 5 8 2 Q 2 b b ;Tr beast d eerd Idendllsd on ihb hem b eutMdzsd w pey t shown m TOTAL upon proper two. I promise w pey each TOTAL (topethe erry Ihere) to e doer the pea due CUSTOMER: RETAIN THIS COPY FOR YOUR RECORDS �mnd N ecooraence with the eoreemem Wven*V the usa d such eerd 40 DATE RECEIPT DESCRIPTION AMOUNT YOUR NEW YOUR OLD RECEIVED OF NUMBER RECEIVED BALANCE BALANCE MARTIN UNIVERSITY 374 2171 AVONDALE PLACE INDIANAPOLIS, INDIANA 46218 �ARTX� (317) 543 -3248 N IV ERSX" y 1 SIGNATURE RECEIPT Martin University Y 8/20/09 05:55 pm Final Grade Report L� MgRTIN� Term: SP -09 'JNIVERS�� Page, James E 3961 N Broadway Student ID 404 -78 -3334 Indianapolis IN 46205 Phone: (317) 714 -3199 College Level Masters Degree Program: URBAN MINISTRY STUDIES Advisor L. Wayne Smith UMS 529 50 Pastoral Care Issues 3.0 A 3.0 12.0 UMS 552 50 Philosophy of Religion 3.0 A 3.0 12.0 UMS 573 50 Field Education 1 3.0 A 3.0 12.0 P e Term: 9.0 9.0 9.0 36.0 4.000 100.0% Cumulative: 48.0 111.0 48.0 177.5 3.700 100.0% 2171 AVONDALE PLACE P.O. BOX 18567 INDIANAPOLIS, IN 46218 (317) 543 -3235 FAX (317) 543 -4790 0� Tu ci ac v psi 4 0 oqo 18 0 0 -4o I oa S b IUD �1 ,05 RECEIPT AMOUNT YOUR NEW YOUR OLD DATE NUMBER DESCRIPTION RECEIVED BALANCE BALANCE RECEIVED OF MARTIN UNIVERSITY 37491 2171 AVONDALE PLACE INDIANAPOLIS, INDIANA 46218 'ART (317) 543 -3248 i SIGNATURE RECEIPT J ►�S -aw 9`OTY:7 CLASS s Y,DE IPTI aO J YA W W DATE JP, 7q A SUB a U �D� TOTAL w N REFERENCE NO. SERVER TAX U ID- FOLIOlCHECK NOJLIC. N0. STATE REGJDEPT. CLERK TIP MISC. XGN�c HERE 58 202 6 6 06 G 0� ft Bauer of t9card klenNed on mle Item Is ar*dzed m pe y ma, nt shown as TOTAL span proper pteeentaNOn. I prombe m pa such TOTAL (lopetherlwtth any other due es�em) sugedtmendmemotdencewhhteapreemempoveminptheuaeoreu= CUSTOMER RETAIN THIS COPY FOR YOUR RECORDS x, Martin University U 8/20/09 05:55 pm Final Grade Report .Ly MARTIN Term SP -09 Utvf RS1 Page, James E 3961 N Broadway Student ID 404 -78 -3334 Indianapolis IN 46205 Phone: (317) 714 -3199 College Level Masters Degree Program: URBAN MINISTRY STUDIES Advisor: L. Wayne Smith ow if UMS 529 50 Pastoral Care Issues 3.0 A 3.0 12.0 UMS 552 50 Philosophy of Religion 3.0 A 3.0 12.0 UMS 573 50 Field Education 1 3.0 A 3.0 12.0 Term: 9.0 9.0 9.0 36.0 4.000 100.0% Cumulative: 48.0 111.0 48.0 177.5 3.700 100.0% 2171 AVONDALE PLACE P.O. BOX 18567 INDIANAPOLIS, IN 46218 (317) 543 -3235 FAX (317) 543 -4790 City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head n�o commencement of course.) Employee Name e 1�, Department 1v 126G 7 s Educational lrlstituiion R Y /I�l Name of Course* S J) T L �1L /(i Startinu Date ofCourse fmonth"dayiyear) 1-6- By m below, I si- rnit,� that I unuerstand the 'ullovvinU: The tuition reimbursement pro17ram is subject to the terms of Carme'. fir. Code, Section -5 To receive reimbursement for tuition. 1 must submit evidence of ia,ment for the course anti a cop"! of my final .zrade. To receive reimbursement for books. I must submit the book list for th= course and an onginal itemized receipt for all books purchased. if 1 leave Cit�: of Cdi employment sooner than one (11 year after the end tit .his course. 1 \viii repay the City hull for its tuition and book reimbursements for this course. The ta:< status Or reimbursement pay .nts is sublec[ o federal '.a \l'ine'n ma`' c lame iri�m :iT e to [:mC. Fmplc mature Date -2- Part 11 (to be completed by Department Head) I Submit :o Human Resources! n ,v s1Lmm'g below. I ccr that [lie applicant will haA'C Jetn Cmp_cved iU!l me Uv the C:P,f _Ur at !Cast vear prior to [lie commencement Ur flit course, and iias not beta :L1Ulect ;0 :1 dl C:pllnar:' prGJa[IUn, Sll�i t 1`iUn Or demotion v4'Ithin 90 Jays prior 'o die bt'3innlri? ,)C the cUu:Szi. "`e iinal Will 'Je Jalll rOIT [Il`` is parti7]eril DUd?et. �llbleCt 'o the ieTls of Section 2 :9 of m C re' l_vc t. Department Head Si`Mature Dale Part III (to be completed by Director of Human Resources) Date J :tai :a.epro" al I` tnicd, reason fur denial r he Rl:[iotl r,lmEJUrse'lleil[ program c0 ers oni\• full semester courses Ut[ercd [1iroU'_h a degrZ--!rantm :nsil[U[[Un accredited by the \+orth en ra? :\ssociation of Colleges and Schools or an -quicalent regional accr,ditor. n aooiication \\ill nut be consi complete unless a .:ourse description from the school's literature is attaches':. 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 L Department I �11�(j�yyL�iG/I) S T`5 /{LYI S Educational Lnstitution* Name of Course *J 5 Ail Starting Date of Course (montlVdav /year) 1_ 6 0 By si below_ I sit_Tnifv that I understand the following: The tuition reimbursement program is subject to the terms of Carmel Citv Code, Section To receive reimbursement for tuition. I must submit evidence of pavTnent 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 year after the end of this course. I %ill repay the City_ in full for its tuition and book reimbursements for this course. The tax status of reimbursement payments is subject to federal !aw. which may change from time to time. Employee Signature k e Date 2 O N Part II (to be completed by Department Head) (Submit to Human Resources) By siuming below. I certifv that the applicant will have been empioved Lull -time b% the Ciry for at leas one 11) year prior to the commencement of the course. and has not been subject to a discipiinary probation. suspension or demotion within 90 days prior to the beginning of the course. The final claim will be paid -rom :n departments bud_et. subject to the terms of Section 2 -59 of Carmel C its.- Code. Department Head Signature Date Part III (to be completed by Director of Human Resources) Final Approval /��_.PfL Mr�� Date Dg_ It denied. reason for denial The tuition reimbursement program covers only Cull- semester courses offered through a de, _ree zrantinz institution accredited by the North Central Assoeta[lon oC LolleL'es and schools or an equivalent rellonal accredltor. An application will not be considered complete unless a course description from the school's literature is anached. 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 a' kJ Department J 5 �fY1,5 Educational Institution* �G,� A-Z Name of Course mil ZQ, P� <to n� L Cate Is 5/,( e-S Starting Date of Course (month/day /year) 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 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 tat status of reimbursement payments is subject to federal law, which may change from time to tim Employee Signature Date 11 c/ 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 1Z Part III (to be completed by Director of Human Resources) p 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. Pre$cribed b 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 Jarn Pane Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/20/09 1 ui ion Reimbursement for james Page Total 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 Clerk- Treasurer VOUCHER 091 14/09 WARRANT NO. ALLOWED 20 IN SUM OF a` $4,840.00 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1202 Information Systems Board Members PO# or DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or 1202 280 $4,840. 00 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 20 i natu le Cost distribution ledger classification if Title claim paid motor vehicle highway fund