TUITION ASSISTANCE REQUEST

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SEIU 1199NW Healthcare Training Fund

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.


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)




















School and Academic Program Information



We are looking for the date you graduate/complete program


What are you requesting funding for:











SUPPORTING DOCUMENTATION:


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.


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.

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