IMPORTANT: This Education Assistance Repayment form is for Intermountain employees who did not meet the work commitment requirement after receiving educational assistance and need to pay money back to Intermountain Healthcare. After completing this form, payment to Intermountain will be withdrawn from the employee's bank account on file. This form is not for tuition reimbursement for current Intermountain employees. Employees seeking tuition reimbursement should create a tuition reimbursement request in Workday and contact Ask HR with any additional questions.

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Identification
Personal Information
 
 
 
 
 
 
 
 
Education Assistance