Name of College/University: ___________________________________
Number of Credits Received: ___________________________________
Service Agreement Clause:
I ___________________________________________, agree to remain teaching at the Lyons Central School District for a minimum of one full school year beyond the tuition reimbursement year. If I do not fulfill this service agreement, I shall reimburse all monies given to me under this agreement with the Lyons Central School District.
Date of Signature: ______________________________________
Transcripts and receipts for course payment must be attached to this application. Deadline for this application is June 1, 2007. See Q&A sheet on reverse side for more information.