PROFESSIONAL DEVELOPMENT SVC/PRO TECH REIMBURSEMENT FORM

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SEIU 1199NW Healthcare Training Fund

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: 


NOTE: PER DIEM & CONTRACT EMPLOYEES ARE NOT ELIGIBLE FOR THIS SERVICE
For program details, eligibility, what activities can be reimbursed, and other details, please visit the professional development page on our website.

The standard processing time once all standard supporting documentation received is 30 Days.

Supporting Documents are necessary before continuing:
  1. Proof of Payment/Cost: Please submit the detailed invoice/receipt from the organization listing the total amount you paid, the goods/services you paid for, your name, the organizations name, and the date paid.
  2. Proof of Completion: This must show that whatever activity you have paid for has been completed entirely. 
Examples: if you paid for 14 Continuing Education Units (CEU's) and submit only 2 completed CEU's we will not be able to reimburse you. Or if you paid for a conference where you will obtain CEU's, we can only reimburse you after proof is provided that you obtained the CEU's.

For Study Materials/activities that are not providing CEU's directly: there is no proof of completion needed, just proof you received the materials, and proof of payment/costs.

For Membership renewals: PER the Board of Trustees your Training Fund NO LONGER requires proof of CEU's obtained during your membership period. You membership is still required to provide access to CEU's - but we will no longer need proof you have obtained them.

If you have any questions please email members@healthcareerfund.org or call 425-255-0315. If you need help uploading documents, please visit our Help with Online Tools page.

This form covers activities completed in 2020. Activities completed in 2019 cannot be reimbursed after the 12/31/2019 deadline.

(Activities completed in 2020 and paid for in 2019 can be reimbursed using this form.)

EMPLOYEE INFORMATION: For your name please give us the full first and last name your employer has on file (no nicknames).





















Professional Development  Activity Information











No $ necessary




Required Supporting Documentation:


For CEUs/Courses/Conferences:

You must submit documents showing proof of payment and attendance/completion. Your proof of payment must include your name, the name of the sponsoring organization that was paid, the amount paid and the date paid. Your materials must also demonstrate that you not only paid for but actually took the course/CEUs or attended the conference. (Examples may include CEU certificates, sign-in sheets from events, etc.)

For Exams/Certifications:
You must submit documents showing proof of payment and completion of the exam/certification. Your proof of payment must include your name, the name of the sponsoring organization that was paid, the amount paid and the date paid. Your materials must demonstrate that you not only paid for, but actually completed the exam/certification. You may be reimbursed for your exam costs regardless of whether you pass or fail.

For Study/Review Materials:
You must submit documents showing proof of payment. Your proof of payment must include your name, what you purchased, the amount paid, and clearly illustrate what the purchase was for (if not obvious from title of materials.)

For Professional Memberships:
You must submit documents showing proof of payment. Your proof of payment must show that the membership is in your name, the name of the sponsoring organization that was paid, the amount paid and the date paid. *NOTE: If you’re requesting reimbursement for a professional membership that the Training Fund has paid for in a prior year, you must include proof of CE activity with that organization in order to have your membership paid again.

After you submit the form, within a few minutes, you will receive an email from SEIU 1199NW Training Fund via Conga Sign (please check you junk/spam for this). That email has a blue 'View Document' button to click at which point you will begin the electronic signing process. Click here for a walkthrough of the signing process you can review.
Under penalty of perjury, I state that the information provided is correct. By signing this form, I approve the Training Fund to issue funding on my behalf.

SEIU 1199NW Training Fund | 15 S. Grady Way, Suite 321 | Renton, WA 98057 | (425) 255-0315 | www.healthcareerfund.org | members@healthcareerfund.org