LAJTI UNIVERSITY ACCESS COURSE SUBSIDY APPROVAL FORM

Please complete and submit the course subsidy approval form in order to lock in your subsidy for the course of your choice. Forms must be submitted no later than the third week of class. If you have question, contact David Lewis at dlewis@bjela.org or 323-761-8618.

First Name

Last Name

CONTACT INFORMATION

Work Phone

Mobile Phone

Current Employer

Job Title

How long have you been working at your current position?

Describe the Jewish experiential educational aspects of your work:

Name of your direct supervisor:

Contact information for your supervisor:

COURSE REQUESTED

Institution:

Course Number and Title:

How will this course impact your work? How will this course make you a better teen experiential Jewish educator?

SPECIAL ADDITIONAL SUBSIDY!

Would you like to receive an additional $100 off the price of your course? If your employer contributes $50 towards covering the cost of your course, University Access will give you a matching $50 additional subsidy!! (Pierce College courses not eligible for this additional subsidy).

Check this box if you wish to receive the signature form that verifies your employer's commitment to pay $50 towards your professional development.

I wish to receive the employer matching subsidy form

If you would like to submit a course for subsidy not on the pre-approved course menu, please provide in the space below the course title, a brief description, name of the institutional course provider, contact information for the provider, cost of the course and a brief explanation of how this course will enhance your practice.

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