Tuition Reimbursement Request Form and Application

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I hereby submit the course(s) described above for approval under XYZ Company’s Tuition Reimbursement Plan. I understand that a grade of “C” or better is required for reimbursement. Income tax laws frequently change on the taxability of educational benefits and deductibility of expenses. XYZ Company will withhold appropriate taxes on applicable refund checks issued to employees.

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