TUITION ASSISTANCE REQUEST

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The standard processing times once all required back-up documentation is received are 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 this form. 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: Unless you already have one on file at the Training Fund, please submit a program requirement document that lists all the courses required to complete your program and any electives needed.

Proof of course registration and costs: You 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: Submit documentation for books or supplies you are seeking funding for that 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: Please submit 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.

If you need help submitting documents, please visit our Help with Online Tools page or contact your Education Navigator.

You must have your supporting documents ready to upload before continuing:

I have my supporting documents or will work with my Education Navigator if I need help obtaining them

NOTE: PER DIEM & CONTRACT EMPLOYEES ARE NOT ELIGIBLE FOR THIS SERVICE

EMPLOYEE INFORMATION (your name should be the same as your employer has on file, no nicknames please)

First Name (as your employer has it)

Middle Initial

Last Name (as your employer has it)

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal

Preferred Phone Number

Mobile Phone

Work Phone

Home Phone

Primary Email

Email (please be sure you DO NOT share this email with another hospital worker such as a family/friend/co-worker/spouse/child - each person needs to have their own email. You can use your work email if you don't have a personal email.)

Employer

Department

Job Title

Bargaining Unit

Current FTE (Full Time Equivalent)

Date of Hire (mm/dd/yyyy format)

School and Academic Program Information

Name of Academic Program

Anticipated program completion date (mm/dd/yyyy format)

We are looking for the date you graduate/complete program

School Name (if you do not see your school/institution listed please contact your Education Navigator as soon as possible as you may need to work with them to approve a new school/institution. Some institutions in this list will still require additional work with your Regional Education Navigator. Our processing team members along with your Education Navigator will reach out to you if that is the case.)

What are you requesting funding for:

Tuition

Yes

Books

Yes

Supplies

Yes

Application/Exam Fee/Other Required Fees

Yes

Enrollment Term

Enrollment year (eg. 2019, 2020, etc.)

I am requesting funding for a Tuition Expense that...(if you need to submit for a reimbursement as well as a voucher you will need to submit two separate funding requests)

Lead Source

Record Type

Opportunity Name

Opportunity Stage

SUPPORTING DOCUMENTATION:

*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.

If you have financial aid: Please submit 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.

If you need help submitting documents, please visit our Help with Online Tools page or contact your Education Navigator.

Supporting Documentation (could be a registration listing your courses, a transcript from the last courses we funded, as well as any costs or Financial Aid letters if necessary)

On the Next Page you will be able to review all of the information you are submitting to the Training Fund. Please be sure your contact information is accurate, and your backup documentation has been uploaded. At the bottom of that page you will need to sign your request with your mouse. The Training Fund cannot process a request that is not signed.

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.

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