Education Assistance Payment Form

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For Employee SSN: The - symbol must be used between the groups of numbers. E.g. 111-11-1111. Error 1.1 would signify an invalid SSN or invalid formatting.




If applicable. This may be required by your school for the payment to be credited to your account.
Scholarship awards are made in two half payments of the total award. One for Spring Semester and one for Fall Semester. 
Trilogy Preferred Education Partners
Employees who attend Preferred Education Partners are eligible for the following:
  • Tuition Deferral: Portion of payment which would be covered by the Trilogy Education Plus program (if opted in) is due at end of semester rather than at the start. These payments will be made if recipient is still employed with the company at time of payment and passed their courses with Cs or above.  
  • Foundation Scholarship: Employee will receive scholarship as awarded in first month of semester. 
  • Trilogy Education Plus: Employees are eligible to receive up to $2,000 per year of additional education funds from Trilogy Health Services.
Employees who attend Non-Preferred Education Partners are still eligible to receive awarded scholarship, but will not receive tuition deferral or Trilogy Education Plus funds. 

Select Other for non-preferred partner.







The Trilogy Education Plus program provides additional funds provided by Trilogy Health Services:
  • Up to $2,000 per year for education expenses, divided into a maximum of $1,000 per semester.
Please Note: You must agree to the following terms to receive Trilogy Education Plus:
  1. In exchange for this payment , the employee agrees to work for the Company for a period of one(1) year from the completion of the course and receipt of Trilogy Education Plus. 
  2. If you leave employment prior to that time you agree to reimburse the company a pro-rated amount of the tuition/course expenses that will be deducted from your final paycheck.
  3. If your final paycheck does not cover the pro-rated reimbursement amount you agree to reimburse the company through Money Order or Certified Check for the remaining balance.


Tuition Reimbursement Requirements
Please Note: In order to complete this form you will need the following:
  1. A copy of your grades for the courses for which you are requesting reimbursement
  2. Invoice for the course(s) being submitting for reimbursement.
  3. You must have received approval from the Scholarship Committee by applying through the Education Assistance form prior to requesting these funds.
Please Note:You must agree to the following terms to receive reimbursement:
  1. In exchange for this payment , the employee agrees to work for the Company for a period of one(1) year from the completion of the course and receipt of tuition reimbursement.
  2. If you leave employment prior to that time you agree to reimburse the company a pro-rated amount of the tuition/course expenses that will be deducted from your final paycheck.
  3. If your final paycheck does not cover the pro-rated reimbursement amount you agree to reimburse the company through Money Order or Certified Check for the remaining balance.
  4. If you leave employment with the company prior to completing the course and you have not worked with the company one(1) year following your last tuition reimbursement payment, you agree to repay the full amount of tuition reimbursement that you have received.
Reimbursement Amount
The Amount you will be reimbursed is dependent upon the grade you received in the course(s). The following numbers show the percent of what you paid that you should expect to receive up to $2000.
Reimbursement will be made on the following schedule:
  • A: 100%
  • B: 75%
  • C: 50%
  • Lower than C: 0%
  • Pass (Pass/Fail Course): 75%
  • (75% for Pass, No Reimbursement for Fail)
Tuition Reimbursement or Certification Assistance







If applicable. This may be required by your school for the payment to be credited to your account.






Agreement to Terms
My Check-mark below is an acknowledgement that I have fully read, understand, and agree to comply with each of the above terms. I am entering this agreement knowingly and voluntarily and promise to abide by its specified terms.

Please Note: In order to complete this form you will need the following:
  1. Your Account Number for your Student Loan
  2. The address to send checks to your loan provider 
  3. You must have received approval from the GRAD/Scholarship Committee by applying through the Education Assistance form prior to requesting these funds








If applicable. This may be required by your school for the payment to be credited to your account


Scholarship awards are made in two half payments of the total award. One for Spring Semester and one for Fall Semester. 

Select Other for non-preferred partner.