TUITION ASSISTANCE REQUEST

SEIU 1199NW Healthcare Training Fund

Standard processing times once all required back-up documentation is received: 5 business days for vouchers and 30 days for reimbursements.

If you need both a voucher AND a reimbursement you will need to submit two separate requests.


SUPPORTING DOCUMENTATION: BEFORE you submit your request please review the supporting documents outlined below and be sure any that apply are ready for upload to your request form. If necessary, you may fax the documents to 425-255-0347 or email them to members@healthcareerfund.org. Please be sure to upload, or send, your supporting documents as soon as possible to reduce any delay in processing your request.


Class/Program requirements, if not already on file at the Training Fund - standard online printout for your class/program. A program requirement printout should list all the courses required to complete your program and any electives needed. If this is the first time you are submitting for a voucher or reimbursement for your program please include that document.


Proof of course registration and costs - which must include enrollment evidence for the individual classes you are seeking funding for, your name, the school/institution name, and the cost of those classes (and/or fees if you are submitting for a fee such as an application or transcript fee). 

*For reimbursements - the costs need to be listed as paid and/or include a receipt such as an email receipt after purchase which will need to list the term you paid for along with your name, the institution's name, and the amount received.


Proof of any books or supplies you are seeking funding for are required/recommended for your class/program; i.e., course syllabus or bookstore printout.


Prior quarter grades/unofficial transcript (if applicable: prior quarter grades for any courses paid for by the Training Fund must be on file with our office before additional tuition assistance funds can be released. If you are seeking reimbursement, your grades must be included with your reimbursement request.)


If you have financial aid - a copy of your financial aid award letter.


Depending on the nature of your request we may need more information and you will contacted by one of our Member Service Representatives or your Education Navigator by email (preferred) or phone.


By signing this form I authorize the Training Fund to issue funding on my behalf.

I certify that I do not have a written corrective action on file with the my employer for the previous one-year period and I understand that my corrective action status is subject to verification by the Training Fund.

Under penalty of perjury, I state that the information provided is correct.
EMPLOYEE INFORMATION (your name should be the same as your employer has on file, no nicknames please)




















School and Academic Program Information



We are looking for the date you graduate/complete program


What are you requesting funding for:











IMPORTANT NEXT STEPS!

The next page is where you will tell us what classes, books, or supplies your request is for. Please provide us with backup documentation so we can easily process your tuition assistance request.

If you attend WGU please do not add your courses on the next page and skip to uploading your supporting Cumulative Account Summary, and transcript.
When providing course information, please provide the information as it exactly appears on your official student registration (no web schedules accepted).

If you attend WGU - DO NOT add your courses below. Skip to uploading your supporting Cumulative Account Statement and Transcript on the next pages.





























SUPPORTING DOCUMENTATION:


Class/Program requirements, if not already on file at the Training Fund - standard online printout for your class/program. A program requirement printout should list all the courses required to complete your program and any electives needed. If this is the first time you are submitting for a voucher or reimbursement for your program please include that document.


Proof of course registration and costs - which must include enrollment evidence for the individual classes you are seeking funding for, your name, the school/institution name, and the cost of those classes (and/or fees if you are submitting for a fee such as an application or transcript fee). 

*For reimbursements - the costs need to be listed as paid and/or include a receipt such as an email receipt after purchase which will need to list the term you paid for along with your name, the institution's name, and the amount received.


Proof of any books or supplies you are seeking funding for are required/recommended for your class/program; i.e., course syllabus or bookstore printout.


Prior quarter grades/unofficial transcript (if applicable: prior quarter grades for any courses paid for by the Training Fund must be on file with our office before additional tuition assistance funds can be released. If you are seeking reimbursement, your grades must be included with your reimbursement request.)


If you have financial aid - a copy of your financial aid award letter.


Depending on the nature of your request we may need more information and you will contacted by one of our Member Service Representatives or your Education Navigator by email (preferred) or phone.


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