PCA Tuition Reimbursement Application

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Standard Deadlines:

SPRING SEMESTER - JAN.15
SUMMER SEMESTER - MAY 31
FALL SEMESTER - AUG.31
WINTER SESSION - DEC. 15

PCA Tuition Reimbursement Policy:

In order to be a PCA eligible for tuition reimbursement, you:

must be working with a consumer-employer in Connecticut
must have worked for at least 3 consecutive months prior to the application opening. (The Fund office receives monthly payroll reports which are used to verify eligibility.)
must be enrolling in or enrolled in a healthcare related program (pre-requisite courses are also eligible).

Applications must be received by the deadline or they will not be reviewed and marked ineligible.

Within 60 days of class completion, all receipts and grades must be submitted to the Fund office to be considered for reimbursement. (Upon application, we will notify you how to get these documents to us.)

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Personal Information

First Name

Last Name

Social Security Number

Home Mailing Address

City

State

Zip Code

Telephone Number

Email

Race/Ethnicity

Gender

Date of Birth

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Degree/Certification Pursued Training Information - Please fill in to the best of your ability.

Semester/Training Start Date

Semester/Training End Date

Name of Educational Institution

Name of Other Educational Institution

Address of Educational Institution

Degree/Certification Pursued

You may be asked to provide a course outline (?) to verify which classes are prerequisites or which classes are related to healthcare if your program itself is not healthcare-related.

Total Estimated Tuition & Fees Cost

Total Amount Requested (up to $1,000)

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I certify that I have reviewed the PCA Tuition Reimbursement Policies and will comply with them. I understand that I will receive emailed correspondence regarding my application and I will need to ensure that I meet all deadlines outlined within the policy to be considered.

Confirm

Yes, I agree.