Tuition Reimbursement/Certification Request Form

Employee Name Manager Name

Title Start Date

Term (check appropriate boxes and fill in blanks  Quarter  Semester  Year Term Dates
1  2  3  4
College/Certification Agency Classroom Program  Yes  No
Online Program  Yes  No
Course Title Credit Fees (INR)

 I am  I am not receiving other financial aid (Scholarship - If yes, provide documentation of amount and how it will be applied)

Class Time (Check one box below) Time off with pay is requested:

 Course times can be accommodated outside my normal Hours for Class Time (per week) ______
working hours, and I do not request time off
Total number of weeks in term ______
 Course times will be accommodated by an adjusted work
schedule

The following information is to be completed by the Direct Manager

Provide a brief description of the employee’s current job assignment:

Why do you approve/recommend this course/certification:

I have read and understood Fortinet Tuition Reimbursement/Education Assistance Policy. I agree to the clause pertaining to the payback rule incase if
I decide to leave the company within one year post completion of the certification/course.

Employee Signature Date Manager Signature Date

HR Signature Date

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