Employer Reimbursement

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Employer Reimbursement Form

LTC Student ID:

First Name:

Last Name:

Company Name

Company Contact Name

Company Phone #

Total Per Class Amount Owed.
Pay on your MYLTC or call 920.693.1366 to pay by phone
This agreement is not active until this is paid and forms are received.

Enter Total amount owed

Enter very last class end date you are enrolled in.

Payment Due Date
(6 weeks after very last class end date)

Term
Check the box for the term this pay option is for.

Fill in the class number or name.
$50 down payment per class

Summer

Class one

$50.00

LOG INTO MYLTC OR CALL 920.693.1366

Fall

Class Two

$50.00

TO MAKE DOWN PAYMENT.

Spring

Class Three

$50.00

PAYMENT NEEDED TO ACTIVATE THIS PAY OPTION.

Class Four

$50.00

Please upload a copy of your Employer's Tuition Reimbursement Policy here.

I understand that I am liable for the full payment of fees. I will pay $50 per class down payment I agree to pay Lakeshore Technical College
the balance deferred if the anticipated funding as stated in this agreement is not received for any reason.

Official withdrawals and requests for refunds or adjustments must be made in writing to Student Records at LTC-Cleveland. If you do not officially withdraw from a class, you will be responsible for full payment of that class according to the refunding policy below.

If I officially withdraw from class (es) or college, I will be granted a refund (or receive a fee adjustment) in accordance with the Wisconsin Technical College System Board Refund Policy which states: students enrolling in courses are entitled to fee refunds equal to 80 percent of the fees if they withdraw before or at the time 10% of the course’s potential hours of instruction have been completed. If students withdraw after 10% but before more than 20% of the course’s potential hours of instruction have been completed, they are entitled to a fee refund equal to 60 percent of the fees. If students withdraw after 20% of the course’s potential hours of instruction have been completed, they are not entitled to a fee refund. No refunds will be considered for advanced standing test out or placement fees.

Time Remaining in Class Refund Percent
99-90% .............................................. 80%
89-80% .............................................. 60%
Less than 80% ..................................... 0%

I understand the following:

*By clicking the submit button this is a legal document that will remain on my file that I owe these charges.

*Any amount not paid by due date will result in a late fee of $100 per semester.

*Accounts over 120 days past due will be turned over to Wisconsin State Debt Collection (SDC) or State of Wisconsin Tax Refund Intercept Program (TRIP) depending on amount owed to LTC outstanding.

*My student file will be restricted and no further enrollment will be permitted on present and future terms. • Requests for official transcripts will be denied until balance due is paid in full.

*If payment method is returned for insufficient funds or other reason, my account will be charged $25.

Lakeshore Technical College (LTC) does not discriminate against protected classes, including but not limited to race, color, national origin, religion, sex, or gender – including sexual orientation, gender identity, gender expression, disability or age in employment, admissions, or its programs or activities. To handle inquiries regarding LTC’s nondiscrimination policies, contact the Manager of Access, Equity, and Inclusion for students 920.693.1120, nicole.yang@gotoltc.edu / Executive Director of Human Resources for staff/others 920.693.1158, marissa.holst@gotoltc.edu. LTC, 1290 North Avenue, Cleveland, WI 53015.
TTY 711 gotoltc.edu/equal-opportunity-statement

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