AILA Tuition Assistance Submission Form

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* 1. Your Name

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* 2. Member Number

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* 3. Email Address

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* 4. Date of Submission Request

Date / Time

Date

Time

AM/PM

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* 5. Conference, Seminar, or Online Course Name

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* 6. Tuition Assistance Request

Full

Partial

Either

Supporting Statement:

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* 7. Additional Information: