COMMUNITY SUPPORT SERVICES

Tuition Reimbursement Request

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Name

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Address

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Phone Number

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School/University

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Current Cumulative GPA                                            Current Semester GPA

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Semester (Spring, Summer, Fall)

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School Year @ beginning of semester (Sophomore, Junior, Senior)

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Major                                                                           Credit hours to date              

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Length of employment @ CSS                                   Hours per week worked (minimum)

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Total Tuition per current semester                              Amount Requested

How will the CSS tuition reimbursement program help you?

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