Entitle your document "Request for Tuition Reimbursement." Your employer should know exactly what you are asking for rather than having to search through a document for a specific request.
Begin the request by giving your name, employer and position within the company.
List each course for which you would like to receive reimbursement.
Provide course dates, the academic institution that offered the course, your grade for the course and the cost of the course plus any necessary books or supplies.
Give a brief description for each course as to how it relates to your job.
Provide the total amount for which you are seeking reimbursement.
Attach copies of your financial receipts for your courses, as well as your academic transcript.