RN SPECIALITY CERTIFICATION OR RECERTIFICATION REIMBURSEMENT FORM

SEIU 1199NW Healthcare Training Fund

As an eligible RN, you can be reimbursed up to $300 per year for specialty nurse certification exam and re-certification fees. 

Specialty nurse areas include (but not limited to):
  • Medical Surgical nursing
  • Inpatient Obstetric nursing
  • Maternal Newborn nursing
  • Neonatal intensive Care nursing
  • Critical Care nursing (CCRN)
  • And more!
Backup Documentation Necessary:
  1. Proof of Payment/Costs: detailed invoice/receipt with certifying organization name, your name, the exam/certification name you are pursuing, the date paid and the total paid.
  2. Proof of Certification/re-certification/exam results: a copy of your certification or letter from the organization recognizing your certification/re-certification.
For exams: you DO NOT have to pass your exam to be reimbursed! In the case your are needing reimbursement for an exam that you did not pass you need only send us the proof of payment/costs and proof you sat/took the exam from the organization (a copy of your test results will usually suffice along with a receipt of payment).

Standard processing time once all standard backup documentation received - 30 Days

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.
EMPLOYEE INFORMATION (your name should match what your employer has, no nicknames please)



















Professional Development Information










Required Back-Up Documentation:


Certification or Recertification by exam:

All applicants must show proof of payment & cost and proof of completion for reimbursement.

Proof of Payment & Cost:
Plase submit a valid Invoice Receipt from the organization you applied for your certification through. The Invoice will show the Organizations name, Your name, the Date of Payment, The total amount paid (including fees) and a detailed desription of what you paid for.

Proof of Completion:
Your benefit pays for your exam costs regardless of Pass/Fail outcomes. You must submit a document showing that you completed the exam. This must show the name of the sponsering organiztion, as well as your name, and the name of the certification.

Recertification by any means other than exam:
Must submit documents showing proof of payment and evidence of recertification in your name. Your proof of payment must include your name, the name of the sponsoring organization that was paid, the amount paid, and the date paid.

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