NAPM – HOUSTON TUITION REIMBURSEMENT APPLICATION

Applicant Personal Data Date: ________________

Name: _______________________________________________________________________

Address: __________________________________City__________ State: ______ Zip:_______

Home Phone: ______________________ NAPM / ISM Member ID: ___________

e-mail address: _________________________________________________________________

Current Employment
Company Name: _______________________________________________________________

Address: __________________________________City__________ State: ______ Zip:______

Work Telephone: _______________________ e-mail address: ________________________

Your Position: _________________________________________________________________

Length of Employment: _____________ Certification(s): C.P.M. _______ A.P.P. ________

Does company offer Tuition Assistance: Yes ___ No ___

If Yes – How Much per year/semester: _______________

Company Contact for verification_________________________ Telephone ______________

Educational Information
Name of Institution: ___________________________________________________________

Address: __________________________________City__________ State: ______ Zip:_______

Current course(s) enrolled in (please attach proof of enrollment): ____________________________

________________________________________________________________________________

Are you seeking a degree: Yes _____ No _____ If Yes what degree: _________________________

If Yes what is your GPA: ___________________

If No explain how classes pertain to your career: _________________________________________

________________________________________________________________________________

Do you receive any grants or scholarships Yes___ No ___

If Yes Contact Name ___________________________ Telephone Number___________________

Anticipated out-of-pocket expenses: Spring ___________ Summer __________ Fall ___________

Note: In addition to completion of this application the following documents should be attached:

1. Essay – The essay should be double spaced, and 2 pages maximum. Please include in the essay a brief introduction of yourself, the purpose of your education, your history of participation within NAPM-Houston and any community service programs that you are involved with.
   
2. Proof of enrollment, such as a paid fee statement, will be needed in order to verify enrollment. Please include a telephone number to the Office of Enrollment Services.
   
3. Proof of GPA if applicable. Failure to maintain a minimum of a 3.0 GPA on a 4.0 system will disqualify you. (GPA is not applicable if you are enrolled in continuing education courses or if you are a new student.)
   

Contact Kathy Silverberg C.P.M.,Phone : 713-507-4378 or Email: ksilverberg@reefindustries.com  for instructions on forwarding the completed application