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Home My WebLink About167589 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 361329 Page 1 of 1 ONE CIVIC SQUARE CLAY CAMPBELL CHECK AMOUNT: $1,462.90 CARMEL, INDIANA 46032 9003 MAX COURT o» FISHERS IN 46037 CHECK NUMBER: 167589 CHECK DATE: 1/7/2009 DE PARTMENT AC PO NUMBER INVOICE N AMO UNT DE SCRIPTION 601 J 5023990 914.32 TUITION 651 5023990 548.58 TUITION 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 C` U e L2:' y L—" Department `.Uc A yh C_,� C Y E c` v�5 SSN I Hire Date Educational Institution* J Name of Course** V\ f V\S V C\AA 1 V l Starting Date of Course (month/day /year) V� V 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. O 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. G 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 G G Date A t_ 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 (l) 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 Sectio 2 -59 of Carmel City Code. Department Head Signature Date d Part III (to be completed by Director of Human Resources) Final Approval `L� Date J 5 v 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 acereditor, An application will not be considered complete unless a course description from the school's literature is attached. 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 t C, L Department W -r e 4rt{ )'y1 SSN 7 o I 9 71-lire Date j 6 Educational Institution* P V Name of Course* U V1, Vc j S �tJ f S f 5 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 tax status of reimbursement payments is subject to federal law, which may change from time to time. Employee Signature Date 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 �-L� GLcs 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. View My Grades Page I of 2 Go to Bottom Student Center Clay Campbell Search for Classes Academic Planning My Academics Grades View My Grades Fall 2008 1 Undergraduate IUPUI change term Class Grades Fall 2008 Official G rades Class i D escri p tion U n i t s Grade Grade Points! HIST-A 390 REPRESENTATIVE AMERICANS 3.00 B+ 9.900 INTENSIVE BEGINNING SPAN-S 132 5.00 C 10.000 /0 6o 506 SPANISH II Term Statistics Fall 2008 From From Combined Cumulative Enrollment Transfer Term Total Credit Total Total Grade Points 19.900 19.900 201.600 Graded units towards GPA 8.000 8.000 74.000 Graded units not for GPA 50.000 In progress units GPA** 2.488 2.488 2.724 GPA Total Grade Points Graded units towards GPA Transfer Credit column information reflects the Transfer, Test and Special/Other Credit for this term, Statistics represent the grade points and hours as evaluated by the academic policies of your academic school/program. Go to "My Academics Grades" to run an Indiana University unofficial transcript to view your Indiana University GPA and Hours in addition to your Student Program statistics. Printer Friendly Page Search For Classes Academic Planning My Academics Grades Student Center Go to Top INDIANA UNIVERSITY IUPUI Office of the Bursar PO Box 6020 Account Statement 6 o0At o o o 0 Statement Date: 08/06/08 Page 1 of 1 Due Date; 08/19/08 Billing Reference: IN BILL# XXX1259552 'Previous Balance 0.00 University ID: 0001963789 Mi him um Due', 843.29 Student Name: Campbell,Clay Samuel Total Due 2,045.72 Statement notification sent to clscampb @iupui.edu Charges and Adjustments 07/30/08 Activity Fee 68.45 07/30/08 Technology Fee 177.10 07/30/08 General Services Fee 20.00 07130/08 Resident Undergraduate Fees 1,741.60 07/30/08 Athletic Development Fee (SAF) 38.57 Total Charges and Adjustments: 2,045.72 Messages 4 a IZ70 c�ed hie. Paying at least the minimum payment amount due as indicated will enroll you in the installment plan program. There will be a non refundable Please see a copy of the IUPUI Bursar newsletter at www.bursar.iupui.edu The University reserves the right to restrict services, deny registration, impose late fees, assess returned item service charges, terminate any If paying by check we may choose to convert your paper check into an electronic transaction. The amount of your check may appear as an electronic You agree that if another person submits a check on your behalf, that individual is considered your agent and was provided with the information on Make payment online at http.1 /onestart.1u.edu If mailing payment, include the bottom portion of this statement and make check payable to: INDIANA UNIVERSITY detach IUPUI Office of the Bursar University. ID 0001963789 PO Box 6020 Due Date 08119/08 Indianapolis, IN 46206 -6020 Mmimum Due:' 843.29 Total Due 2,045.72 ArTiount Enclosed.:_ Campbell,Clay Samuel 9003 Max Ct Fishers, IN 46037 Kisumu, NYANZA IUPUI Lockbox USA Payment Processing Center PO Box 7245 Indianapolis, IN 46206 -7245 AIUINA000196378900000000204572000000000843295 QuikPAY(R) Print Payment Receipt Page 1 of 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 3575731 Payment Date: Jan 4, 2009 at 7 :09 PM, EST Effective Date: Jan 5, 2009 Primary User Id: 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $2,000.00 Cardholder's Name: Sara Campbell Payment Method: MASTERCARD *2225 Address Info 9003 Max Court Fishers, IN 46037 Contact Info: (317)441 -8764 (daytime phone) Your payment has been received by Indiana University. QuikPAY(R) Print Payment Receipt Page 1 of 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 3575740 Payment Date: Jan 4, 2009 at 7:11 PM, EST Effective Date: Jan 5, 2009 Primary User Id: 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $170.72 Cardholder's Name: Sara M Campbell Payment Method: VISA "8985 Address Info 9003 Max Court Fishers, IN 46037 Contact Info: (317)441 -8764 (daytime phone) Your payment has been received by Indiana University. Prescribed by State Board of Accounts Form No. 301 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount I 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 Mo. Day Yr. Signature Title 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. Mo. Day Yr. Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ACCT. NO. CARMEL, INDIANA k y mf l� avor Of CAQ�he U f,'�' Total Amount of Voucher Deductions ol.kOY 3 ij Amount of Warrant Month of Yr VOUCHER RECORD Acct. No. Source of Suppl Water Treatment Transmission and Dist. Customer Accounts Administrative and General Operation- Maintenance Utility Plant in Service Constr. Work in Progress Materials and Supplies Customers Deposits Total Allowed Board of Control C F Official Title BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325 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 (n t Department VUc t l W CA Y C J v SSN 21 1 Y 1 1 Hire Date Educational Institution V Name of Course P C 15 V i Starting Date of Course (in V 0 onth/day /year) V N 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 G- Date C- V 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 terns of Section 2 -59 of Carmel City Code. Department Head Signature Date Part III (to be completed by Director of Human Resources) Final Approval Date v 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 acereditor, An application will not be considered complete unless a course description from the school's literature is attached. 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 1611M Department 'W:i�e yVl e f 2 0. V1 SSN 7 o f 7Hire Date s-6 Educational Institution* T u P 0 I Name of Course ,:s �G f f e V f C r �vt 5 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 tax status of reimbursement payments is subject to federal law, which may change from time to time. Employee Signature Date 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 Duman Resources) b �1 S G g Final Approval �iL car 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. View My Grades Pagel of 2 Go to Bottom Student Center Clay Campbell Search for Cla sses Academic Planning My Academics Grades 1 View My Grades Fall 2008 1 Undergraduate I IUPUI change term I v Class G rades Fall 2008 O Grades (Class Description I Unitsl Gradel Grade Points HIST -A 390 REPRESENTATIVE AMERICANS 3.00 B+ 9.900 INTENSIVE BEGINNING S PAN -S 132 5.00 C 10.000 q t,y 6o SU90'�5YyZ SPANISH II l�$y, 4 Term Statistics Fall 2008 From From, Combined; Cumulative Transfer' Term{ Enrollment Credit Total' Total; 1 Total Grade Points 19.900' 19.900. 201.600 I 'Grad unit towards GPA 8.000 8.000; 74.000± iGraded units not for GPA 50.000 In progress units GPA 2.488 2.488 2.724 GPA Total Grade Points Graded units towards GPA Transfer Credit column information reflects the Transfer, Test and Special /Other Credit for this term. Statistics represent the grade points and hours as evaluated by the academic policies of your academic school /program. Go to "My Academics Grades" to run an Indiana University unofficial transcript to view your Indiana University GPA and Hours in addition to your Student Program statistics. Printer Friendl Page Search For Class Academic Plannin My Academi &_Grades Student Center >i Go to Top https:// iuself. iu. edu/ psc /SSERV /SISSELFSERVICE/HRMS /c /SA LEARNER SERVICES.... 1/4/2009 INDIANA UNIVERSITY P IUPUI Office O Box 020 ftheBursar Account Statement Statement Date: 08/06/08 Page 1 of 1 Due'Date 08/19/08 Billing Reference: IN BILL# XXX1259552 Previous Balance 0.00 University ID: 0001963789 Minimum Due 843.29 Student Name: Campbell,Clay Samuel Total Due 2,045.72 Statement notification sent to clscampb @iupui.edu Charges and Adjustments 07/30108 Activity Fee 68.45 07130/08 Technology Fee 177.10 07/30/08 General Services Fee 20.00 07/30/08 Resident Undergraduate Fees 1,741.60 07/30/08 Athletic Development Fee (SAF) 38.57 Total Charges and Adjustments: 2,045.72 Messages Zdable Paying at least the minimum payment amount due as indicated will enroll you in the installment plan program. There will be a non re Please see a copy of the IUPUI Bursar newsletter at www.bursar.iupui.edu The University reserves the right to restrict services, deny registration, impose late fees, assess returned item service charges, terminate any If paying by check we may choose to convert your paper check into an electronic transaction. The amount of your check may appear as an electronic You agree that if another person submits a check on your behalf, that individual is considered your agent and was provided with the information on Make payment online at httpJ /onestarL!u.edu If mailing payment, include the bottom portion of this statement and make check payable to: INDIANA UNIVERSITY detach IUPUI Office of the Bursar University ID 0001963789 PO Box 6020 Due Date 08/19/08 Indianapolis, IN 46206 -6020 Minimum Due 843.29 Total Due 2,045.72 Amount Enclosed Campbell,Clay Samuel 9003 Max Ct Fishers, IN 46037 IUPUI Lockbox Kisumu, NYANZA Payment Processing Center USA PO Box 7245 Indianapolis, IN 46206 -7245 AIUINA0001963? 89000000002045 ?2000000000843295 QuikPAY(R) Print Payment Receipt Page 1 of 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 3575731 Payment Date: Jan 4, 2009 at 7:09 PM, EST Effective Date: Jan 5, 2009 Primary User Id 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $2,000.00 Cardholder's Name: Sara Campbell Payment Method: MASTERCARD *2225 Address Info 9003 Max Court Fishers, IN 46037 Contact Info: (317)441-8764 (daytime phone) Your payment has been received by Indiana University. https:H quikpayasp. com/ iu/ qp/ epay /preparePrintPaymentReceipt.do 1/4/2009 QuikPAY(R) Print Payment Receipt Page 1 of 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 3575740 Payment Date: Jan 4, 2009 at 7:11 PM, EST Effective Date: Jan 5, 2009 Primary User Id: 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $170.72 Cardholder's Name: Sara M Campbell Payment Method: VISA Address Info 9003 Max Court Fishers, IN 46037 Contact Info: (317)441 -8764 (daytime phone) Your payment has been received by Indiana University. https: quikpayasp. com/ iu/ qp/ epay /preparePrintPaymentReceipt.do 1/4/2009 Fo No 301 -S St(e Bo Rev. 995) Accounts ACCOUNTS PAYABLE VOUCHER Fom No. 301 TO ADDRESS Invoice Date Invoice Number Item Amount I 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 19 Signature Title 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. Officer Title Vou No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS SANITATION DEPARTMENT ACCT. CARMEL, INDIANA No. (My �A�iPl� Favor Of Total Amount of Voucher Deductions 0105 0 VQ 0 -7 s /g 5� Amount of Warrant Month of 19 Acct. VOUCHER RECORD No Collection System Operation Plant 1 Commercial General Undistributed Construction Depreciation Reserve Stock Accounts Merchandise Total Allowed Board Members Filed r BOYCE FORMS SYSTEMS 1-800- 382 -8702 325