UFCW Member Application for SEIU 1199NW Career Counseling

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Health Training Fund
Welcome to the SEIU Healthcare 1199NW Multi-Employer Training and Education Fund!

If you are a UFCW-21 represented worker at MultiCare, then this is the right application for you!


Completing this application will connect you to important support and guidance on your pathway to LPN or RN.


The SEIU 1199NW Training Fund, UFCW Local 21, and MultiCare have collaborated to support you. 

Hospital Employee Education and Training projects (HEET projects) like this are designed with healthcare workers like you in mind. To create innovative opportunities for advancement through community college education.


Our goal is to figure out holistically at what it will take for you to be ready to successfully access, persist, and complete your education and career goals. Your answers on this intake enable us to better understand you, so we can do that.


HEET partners on this project include MultiCare and UFCW-21along with Green River College, Pierce College, and SEIU Healthcare 1199NW Multi-Employer Training and Education Fund—all working together for a stronger healthcare workforce!


After you complete the form, the Training Fund HEET Project Navigator will reach out to you to schedule a walkthrough of the details relevant to you, and support you to be on track.


If you need help completing this form, please contact Joshua Porter the HEET Project Navigator at jporter@healthcareerfund.org.



BACKGROUND INFORMATION (the Training Fund’s grant funders use background information to determine our eligibility for grants and other support)

BACKGROUND INFORMATION, CONTINUED (the Training Fund’s grant funders use background information to determine our eligibility for grants and other support.)


FTE between 0 and 1.0


CURRENT LIFE/EDUCATIONAL CHALLENGES – (how can we best support you? Will other outside support we assist with be helpful? Your feedback helps the Training Fund identify other qualifications for outside support and grants)

Are any of the following issues affecting you or concern you now?

 I have had the opportunity to read and review the SEIU Healthcare 1199NW Training Fund Privacy Policy. By filling out and submitting this Application/Intake Form, I agree to this Privacy Policy and authorize the Training Fund to contact, or my behalf, current or previous employers, Unions, or educational institutions, or other relevant entities, to obtain information that may be necessary for the administration of the Training Fund's benefits. I further understand this authorization is on-going for purposes of administering the Training Fund's benefits.

Click Here to Read the Privacy Policy

Your education and career advancement and training opportunities are important to us. In order to provide you with the up-to-date-service, we occasionally send text messages to our participants about their education and training benefits and services. Standard text messaging rates apply. 

By completing this form you authorize text messaging from Fund unless you decline text messaging. To decline Text Messages, email your Training Fund HEET Project Navigator or members@healthcareerfund.org stating that you do not want to receive text messages. 

You can decline text messages at any time. Under some circumstances this may delay your receiving information on your program(s). Please talk with your Training Fund HEET Navigator (if you don’t have one, one will be assigned on submission of this form) if you have questions on text messaging.
The ability to communicate about Training Fund services to our members and to use information gathered in classes and sessions for further training is important to the Training Fund.

Unless you decline photo/video by the Fund, by completing this form you authorize and agree that the SEIU Healthcare 1199NW Multi-Employer Training & Education Fund and SEIU Healthcare 1199NW may use photographic images or video footage of you, or in which you are included, taken during Training Fund related classes, sessions, or events, for public relations, program marketing, electronic media, or educational purposes.

To opt out from photo/video use, please send a separate email your Training Fund HEET Project Navigator or members@healthcareerfund.org stating that you do not want your images/video to be used for Training Fund purposes.

You may opt out of photo/video use at any time. Please talk with your Training Fund HEET Project Navigator (if you don’t have one, one will be assigned on submission of this form) if you have questions on photo/video use.
The Training Fund is dedicated to equal opportunity education and training. It does not discriminate on the basis of race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, physical or mental ability, veteran status, military obligations, background, or marital status.


You MUST sign at the bottom of this page and click the 'Submit Signed Response' button to complete your application/intake form. You will then receive an email with a link to confirm your Signature…this form is not submitted until it is signed and your signature is confirmed.

I certify that the information provided is true to best of my knowledge. I am aware that the information I have provided is subject to review and verification, and I may have to provide documentation to support the information provided.

I authorize release of this information for verification purposes and for determining eligibility for services and Training Fund and non-training Fund benefits. I agree to the Training Fund Privacy Policy. I understand that receiving services is subject to availability of funding and that training and/or services are not guaranteed.

I desire to be screened for benefit eligibility and enrollments. I authorize the release of my information and job placement data to Training Fund staff and affiliates for program monitoring, research, verification, additional data collection, and evaluation purposes.

By signing with my mouse/cursor or typing my full name below as my signature, and submitting this form, I verify and confirm the statements above.

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