2024-2025 AOHC Tuition Reimbursement Application

Application for Local Health Department staff

Use this page to submit your application and documentation for the 2024-2025 Tuition Reimbursement Initiative.

Instructions:

You MUST have your signed application and fee/course documentation ready to upload BEFORE you begin this application. Do NOT begin the survey if you do not have your documentation ready to upload.

Please combine all your documentation into 1 PDF document if possible.

File uploads are limited to 16MB. If necessary, break your file into smaller documents to upload (Questions 14-19).

While we value your privacy and security, PLEASE REDACT any personal identifying information such social security number or birthday.

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Applications will not be processed until all documentation is received.

The Tuition Reimbursement Policy and Procedures, Application & Agreement Form and instructions are available on the AOHC website. Please see these documents for further information.

Multiple semesters/terms can be submitted on one application form as long as all coursework is completed or currently in progress at the time of submission. You must submit a new application for each reimbursement request. Deadline for submission is June 10, 2025 or until funds run out, whichever comes first.

If you have questions, please contact Kathy Luhn at: aohctuition@gmail.com.

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* 1. Applicant First Name:

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* 2. Applicant Last Name:

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* 3. LHD Agency Name:

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* 4. Have you received or will you receive any reimbursement through the 2023 AOHC Tuition Reimbursement Initiative?

Yes

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* 5. Have you received or will you receive any reimbursement through the 2024-2025 AOHC Tuition Reimbursement Initiative?

Yes

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* 6. Have you received or will you receive any tuition reimbursement from your local health department or other source?

If Yes, please explain.

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* 7. Total Amount of reimbursement requested on this application:

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* 8. Date of completion of the first/earliest course being reimbursed under this program. This includes any AOHC reimbursement, 2023 or 2024-2025.

Date / Time

Date

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* 9. What is your date of hire at your current Health Department?

Date / Time

Date

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* 10. Do you have previous employment with any other Ohio Local Health Department? If yes, please enter the date below and submit documentation with your application.

If Yes, please enter hire date

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* 11. What degree or Certification is being pursued? (Please choose only 1. If more than one category applies, please choose the highest degree you are pursuing.)

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* 12. Please list your major/field of study or Certification sought:

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* 13. Name of school or institution attended:

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* 14. Please list all courses being submitted for reimbursement on this application:

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* 15. Applicant mailing address (where we should send the check)

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 16. BEFORE you upload your documents, please be sure your name is on your attachments, your scanned documents are legible, and verify that your documentation includes the following:

Signed application - Your signature

Approval/Signature of Health Commissioner

Copy of your itemized bill for tuition/fees from the university or provider. Documentation must include:

Fees/expenses, books or other charges

Classes included in the payment/semester or term

Semester/term or date of classes

Degree/certification being pursued

Any scholarships, grants you received

Receipt from school/Proof of payment, including date paid

Record of completed course(s) that includes semesters/terms or dates of classes AND/OR Classes currently in progress

Final grade(s) - must be "C" or above or "Pass"/Complete AND/OR if term is in progress, will submit grades as soon as available, BE SURE YOUR NAME IS ON YOUR TRANSCRIPTS.

Documentation/statement of any reimbursement you have received from your health department or other source or are scheduled to receive

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* 17. Documentation Upload: Application, Fee, and Course Documentation - File Upload

Please scan and upload your signed Application and Agreement Form, copies of bills, receipts and course term/information as one PDF file if possible. File size is limited to 16MB per upload. Break the document into smaller files and upload each section below if needed. Documentation must include: Signed Application and Agreement Form; Itemized Bill; Receipt for payment of tuition and any associated course fees, required books, or required exam fees that you paid; Classes included in the payment, including semester/term or dates; and Documentation of successful completion of the course. See Policy & Procedures for details.

PDF, DOC, DOCX file types only.

Choose File