This form covers professional development activities
completed the current year. Activities completed in the previous year cannot be reimbursed after the
December 31st of that year.
(Activities completed in
the current year and paid for in the previous can still be reimbursed using this form. For example, if you paid for CEU credits in 2020 but did not complete all credits till 2021 you can still receive reimbursement from your 2021 benefit based on your eligibility).
*If you a registered nurse requesting reimbursement for your RN Specialty Certification please use this form: