PRO TECH CONFERENCE TRAVEL & ATTENDANCE FUNDING AWARD REQUEST FORM

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Submit this form to request funding for conference travel and attendance (for our professional/technical members). Funding is awarded based on seniority and availability.

Not all expenses are eligible for reimbursement. For program guidelines, eligible and ineligible costs, and other details, please visit our website.

You must submit supporting documentation showing conference details to complete your application. This information needs to include details such as the start/end dates, the sponsoring organization, and proof that you will receive/obtain CEUs for your participation. If you need help uploading documents, please visit our Help with Online Tools page.

PLEASE NOTE: In order to be considered for an award you must submit your application BEFORE the conference. We cannot consider an award request for a conference that you have already attended. If you have already attended the conference it may be eligible for to be reimbursed up to $300 (pro-rated by your FTE) using your Professional Development reimbursement benefit. You can learn more about that here.

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

EMPLOYEE INFORMATION

First Name

Middle Initial

Last Name

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 and you can always use your work email if you don't have a personal email)

Employer

Worksite location

Note: Only Pro/Tech Bargaining unit members at the above employers qualify for this program!

Department

Job Title

Bargaining Unit

Current FTE

Date of Hire (mm/dd/yyyy format)

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

Conference Information

Conferences must award CEU's relevant to your current position in order to be considered for approval. You must submit documentation showing that the conference does award CEU's.

Conference start date

Conference end date

Will you be awarded CEU's for attending conference

Conference location (City and State)

Conference name

Conference sponsoring organization name

Registration Cost (no '$' needed just numbers. Ex. 220.25)

Lead Source

Record Type

Opportunity Name

Opportunity Stage

Your Manager's Approval is Required in order to process your request. Once we receive your request your manager will be sent an approval document.

Manager's First Name

Manager's Last Name

Manager's Title

Manager's Email

Manager's Phone Number

Contact Record Type

Required Supporting Documentation:

For the award process we only require a scanned or copied brochure for the conference or a screenshot of the conference's website showing the details and proof that you will obtain CEU's from the conference.

Pro/Tech Conference Award Backup Documents

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.

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Contact Information