IBEW/ Verizon

New England Work and Family Committee

Summer Camp Program

Taxable Reimbursement Program

June 1- September 6, 2008

Overnight Camp and Day Camp

Summer Program

IBEW/ Verizon

New England Work and Family Committee

Summer Camp Program

Taxable Reimbursement Program

The New England Work and Family Committee understands the difficulties families face when school is out for the summer. We want to ease your financial obligation this summer and reimburse for summer camp/ day camp programs.

The summer camp program runs from June 1 through September 7, 2007. This program is to enrich your school age child/ren (ages 5-18). The New England Work and Family Committee will reimburse up to $200.00 per week for a maximum of 6 weeks for the period identified above. We will reimburse for overnight summer camps, day camps and summer programs. Your dependent can enjoy the outdoors, learn a skill, or participate in an athletic camp. The summer camp program is not daycare. The monies you are reimbursed are taxable.

Eligibility Requirements

· You must be a member of IBEW, management or non-bargained from MA, RI, VT, NH or ME.

· CWA and IBEW 2213, VIS and Idearc employees are not eligible for this program

· You must have a total household income less than $125,000 for year 2007

· The program is for your dependents ages 5-18 listed on your tax return

· You must have incurred overnight camp or day camp expenses.

If you are on a leave of absence please contact the work and family staff for eligibility.

Camp Eligibility

Camp must be an overnight or day camp summer program that has a tax identification number.

Some camps that are included in the program are: academic camps, adventure camps, arts camps, sports camps and traditional outdoor camps such as YMCA, 4H or Boys/Girls Club.

Family daycare, in home daycare, or programs normally covered by the Dependent Care Reimbursement Program are ineligible for The Summer Camp Reimbursement Program. You may be eligible for the Dependent Care Reimbursement Program (DCRF).

How do I apply?

You can obtain an application by going to www.verizon.com/life and click on union member resources, select New England Work and Family. You can call 617-743-6310 or call your union representative.

· Complete the application in full

· Complete and application for each dependent

If you have enrolled in more than one summer camp program, complete an application for each camp.

· Have summer camp director/ administrative office sign the application after the camp session is completed.

· Application must have original signatures

· Attach receipts or canceled checks to the application

· Send your 2007 1040 federal tax return (dependents name must be on your tax return)

· If your child’s name is not on your tax return because of a recent adoption, please attach documentation.

· Send 2007 employee W2 (must be a Verizon employee).

· You submit the application after all the camp(s) has been attended (please send all forms for all camps in 1 envelope)

How much am I reimbursed?

You may be reimbursed up to $200 per week for a maximum of 6 weeks during the summer from June 1 through September 6, 2008.

Complete the application and return along with your 2007 federal tax return, W2 and receipts for summer camp. The application must be received no later than September 30, 2008. Your reimbursement will be included your paycheck.

You can not claim reimbursement for both The Dependent Care Reimbursement Fund DCRF and the Summer Camp Program.

The employee assumes all responsibility for determining the quality and capability of a childcare dependent care provider, and assumes all responsibility for choosing a provider. I understand that VERIZON and IBEW do not hire, train or supervise child or dependent care providers, nor do they screen, endorse, or recommend any provider of care, nor represent or guarantee that the provider the employee has chosen will provide quality care. VERIZON and IBEW are neither responsible nor liable for any injuries or damages of any nature suffered as result of the acts or omission of a provider of care in the operation of its business.

VERIZON and IBEW retain the right to change the eligibility requirements or amount of reimbursement as well as any other provision of the Dependent Care Reimbursement Fund

Eligibility for reimbursement terminates upon my termination of employment with Verizon

Program is contingent on contract negotiations

This is a Taxable Summer Camp Reimbursement Program

IBEW/Verizon New England Work and Family Committee

2008 Summer Camp

Taxable Reimbursement Program

Complete ALL information. Your application WILL BE RETURNED if any information is missing. Please print clearly or type.

Employee Name Social Security #

Home Address

City State Zip Code

Home Phone

Work Address

City State Zip Code

Work Phone Cell Phone

Email

Circle and fill in local IBEW Local _____________ Management Non Bargained

Do you participate in the Dependent Care Reimbursement Program? NO YES

If yes please name your dependents in the program

(You can not claim reimbursement for both DCRF and Summer Camp)

Are you on leave? yes no If so what kind Dates of leave

1) Dependent Full Name DOB Age

Type of Summer Camp Reimbursement Request Summer Day Camp Summer Camp Over Night

Camp Name

Tax ID Number

Camp Provider’s Address

Camp Provider’s Phone Number

Indicate which week(s) and how much of each week

Week Ending dates

JUNE

JULY

AUGUST

SEPTEMBER

6/14$

7/5 $(6/29-7/5)

8/2(7/22-8/2)$

9/6 $(8/31-9/6)

6/ 21$

7/12 $

8/09 $

6/28$

7//19$

8/16 $

7/26 $

8/23 $

8/30 $

Total for all weeks

Camp Director/Administrative Office Original Signature

(Attach receipts and/or cancelled checks)

You MUST attach a copy of your 1040 and W2 for year 2007, receipts and/or cancelled checks before sending. Only original applications and signatures submitted with 1040 cancelled checks or receipts will be paid.

Employee Authorization:

I, (Print Name) ________________________________________ am requesting reimbursement for the expenses listed above. I have read the criteria of the 2008 Summer Camp Program and agree to abide by them and my signature signifies I abided by the criteria. I certify that all the information I have provided on this form and in the attachments is accurate.

Employee Signature

Send this form and attachments to:

Verizon/ IBEW

Attn: New England Work & Family Committee

15 Chestnut St. Floor 3

Worcester, MA 01609

NO Later than September 30, 2008