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CUNY Tuition Reimbursement Application
MEA Member’s Current Status:
Status
*
Active Member
Retired Member
Member Name
*
Agency/Agency Code
Member Name
*
Agency/Agency Code Retired From
Reimbursement Information:
Reimbursement Is for Which Program?
*
Undergraduate
Graduate
Amount
*
Semester
*
Semester
Fall
Spring
Summer
Year
*
Member’s Personal Information:
Name
*
First
Middle
Last
Home Address
*
Apt. No.
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip
*
Contact Information
*
Home
*
Cell
*
Email
*
Member’s Agency Information:
Work Information
*
Work Contact Information
*
Agency's Name
*
Work Phone
*
Civil Service Title
*
Work Location/Address
*
Level
*
Fax
Office Title
*
College/Institution Information for Reimbursement:
Currently Enrolled
*
Yes
No
College/Institution
Course of Study
Graduation Month
Graduation Year
Which Program Are You Interested In?
*
Undergraduate Certificate
Graduate Certificate Program
Master’s Degree Program
Program Name
*
Address
*
Short Essay
Additional Information Needed:
Allowed file types: PDF | docx | PNG
Maximum File Size: 10MB
New Members
Resume
Accepted file types: pdf, png, docx, Max. file size: 10 MB.
A 250-Word Essay
An essay of at least 250 words that describes your career goals and how pursuing the program of study will help achieve those goals to advance your City career.
Accepted file types: pdf, png, docx, Max. file size: 10 MB.
Receipt of Tuition Payment
*
Accepted file types: pdf, png, docx, Max. file size: 10 MB.
Members
If you subsequently decide to change your program of study, you will be required to notify the MEA Compensation and Professional Development Committee, Attn: Committee Chair in writing before you register for new classes to determine if you will remain eligible for tuition reimbursements.
Electronic Signature
*
First