Tuition Reimbursement Application

TUITION REIMBURSEMENT FORM

Please tell us whether you work in a Nursing Home/Hospital setting or in Home Care

Record ID

PCA Tuition Reimbursement Policy:

ELIGIBILITY WINDOW:

TERMS accepted: Fall 2024 (Sept.-Dec. 2024 courses)
Application period START DATE: 1/17/2025
Application period DEADLINE: 2/9/2025

ELIGIBILTY REQUIREMENTS:

Courses MUST align with the CMS Core Competencies to be considered for reimbursement: https://www.medicaid.gov/sites/default/files/2019-12/dsw-core-competencies-final-set-2014.pdf
Application MUST be received within the open period (dates above)
ALL supporting documentation (tuition invoices, course information with grades, and other applicable documents) MUST be submitted by the application deadline

WHAT TO DO AFTER APPLYING:

Check for your email confirmation
Use the link in the confirmation email to UPLOAD your documents to us by the deadline
Have patience. (We understand this may be the hardest part of the process. Please keep in mind that the review process for tuition reimbursement can take several months. The process not only involves the Training Fund reviewing all your supporting documents, but it also requires the State of Connecticut's review before a final determination can be made.)

Tuition Reimbursement FAQs:

Please note that reimbursement checks will be mailed to your address on file; these payments do not go directly to your educational institution.
We do not reimburse you for courses that are "incomplete," that had a grade lower than a C, and/or that have not been taken yet.
At the time of your application, you need to be an actively working PCA.
We are not considering applications that ask for reimbursement for terms that are not being accepted at this time (please see the list of accepted terms above)
Lastly, your field of study must be health care related and related to the CMS Core Competencies (https://www.medicaid.gov/sites/default/files/2019-12/dsw-core-competencies-final-set-2014.pdf) in order to be eligible.

Personal Information

DO NOT continue filling out and submitting this application if SOMEONE ELSE'S information appears below. This means you are using the incorrect application link. Please contact a member of our team for support!

For CT Nursing Home Workers please email Angela at aalfieri@1199trainingfund.org.

First Name

Last Name

Social Security Number

Home Mailing Address

City

State

Zip Code

Telephone Number

Email

Race/Ethnicity

Gender

Date of Birth

MM/DD/YYYY format

Degree/Certification Pursued Training Information - Please fill in to the best of your ability.

TERM applying for:

YEAR applying for:

Semester/Training Start Date

MM/DD/YYYY format

Semester/Training End Date

MM/DD/YYYY format

Expected Graduation Month

Expected Graduation Year

Name of Educational Institution

Name of Other Educational Institution

Address of Other Educational Institution

Degree/Certification Pursued

You may be asked to provide a course outline to verify which classes are prerequisites or which classes are related to healthcare if your program itself is not healthcare-related.

Total Estimated Tuition & Fees Cost

Total Amount Requested

Please remember that your amount requested may exceed the eligibility amount

Nursing Home & Hospital Tuition Reimbursement Policy:

ELIGIBILITY WINDOW:

All 1199 Members must apply prior to classes beginning AND before the deadlines listed below. Late applications will be denied.

**For Women & Infants Hospital (WIH) members: All 2025 applications must be submitted online NO LATER THAN DECEMBER 15, 2025, NO EXCEPTIONS.**

2025 applications submitted after December 15, 2025, WILL BE DENIED. WIH members had a 1-year 2025 grace period to adjust to the Fund's strict enforcement of deadlines from the prior policy. All late applications will be denied after December 15, 2025. For ALL FUTURE Tuition Reimbursement applications (for 2026) ALL WIH members must apply BEFORE their classes or program BEGINS AND no later than the ANNUAL DEADLINES listed below.

ALL members of the Training Fund across CT and RI must apply no later than the deadlines below:

SPRING deadline = January 15th
SUMMER deadline = May 31st
FALL deadline = August 31st
WINTER deadline = December 15th
NON-SEMESTER deadline = prior to course start date (non-semester conferences, certificate programs, CEUs, etc.)

ELIGIBILTY REQUIREMENTS:

Application MUST be received ONLINE by 11:59pm before the deadline for the corresponding semester (see dates above).
ALL supporting documentation (tuition invoices, course information with grades, and other applicable documents) MUST be uploaded online no later than 60 days after the course(s) has been completed
MUST have worked for 12 consecutive months for a participating employer by the application deadline
MUST have worked an average of at least 8 hours per week during the previous year
MUST continue to work an average of at least 8 hours per week during the semester/term for which you have applied for reimbursement

WHAT TO DO AFTER APPLYING:

Check your email for confirmation (If you apply outside of the open enrollment timeframe, you will receive an email notifying you of your denied application.)
Save your confirmation email, use the link in it to UPLOAD your documents to us by the deadline
Have patience. (We understand this may be the hardest part of the process. Please keep in mind that the review process for tuition reimbursement can take several months. The process takes time for The Training and Upgrade Fund to review all of your supporting documents before a final determination can be made.)

Tuition Reimbursement Policy:

For semester-based programs, an application must be received ONLINE by 11:59pm on the stated deadline. Submit your application by the deadline even if you have not yet registered for your courses. Complete one application for each institution you are attending.
For semester-based programs, ALL receipts and grades must be received ONLINE within 60 days of class completion in order to be considered for reimbursement. Application must be received by 11:59pm on the stated deadline.
For non-semester based programs, short-term training, workshops, Continuing Education (CEUs) or online courses an application must be received ONLINE by 11:59pm on the day before the first day of the program. One form is sufficient for most non-semester based programs, but please call the Fund office if you are not sure about your program's requirements. **Additionally, a college program earning a Bachelors or Masters degree could be NON-SEMESTER BASED if its terms are shorter than a traditional college semester. For example the terms are accelerated, coursework is online or self-paced, etc.
For non-semester based programs, ALL receipts and grades must be received ONLINE within 60 days of completion of the training.
If you are notified by the Fund office that tax forms are required because your current reimbursement will bring your annual total over $5,250, then you must return the tax forms within 2 weeks of this notification.
Your course/class/program of study must have a realistic potential for a Full-Time job in a healthcare facility. Please contact the Fund office if you are not sure if your program of study or if your educational institution is eligible.

**YOU WILL RECEIVE A FILE UPLOAD LINK IN THE CONFIRMATION EMAIL**

If you have any problems with your online applications or run into any errors, please contact Angela at AAlfieri@1199trainingfund.org.

Personal Information

DO NOT continue filling out and submitting this application if SOMEONE ELSE'S information appears below. This means you are using the incorrect application link. Please contact a member of our team for support!

If you have any questions please contact:

CT Nursing Homes, Angela Alfieri aalfieri@1199trainingfund.org

RI Hospitals, Dannerys Taveras dtaveras@1199trainingfund.org

First Name

Last Name

Social Security Number

Home Mailing Address

City

State

Zip Code

Telephone Number

Email

Date of Birth

MM/DD/YYYY format

Race/Ethnicity

Gender

Employer

Job Title

Shift

Date of Hire

MM/DD/YYYY format

Degree/Certification Pursued Training Information - Please fill in to the best of your ability.

TERM applying for:

YEAR applying for:

Expected Graduation Month

Expected Graduation Year

Semester/Training Start Date

MM/DD/YYYY format

Semester/Training End Date

MM/DD/YYYY format

Name of Educational Institution

Name of Other Educational Institution

Address of Other Educational Institution

Degree/Certification Pursued

You may be asked to provide a course outline to verify which classes are prerequisites or which classes are related to healthcare if your program itself is not healthcare-related.

Total Estimated Tuition & Fees Cost

Total Amount Requested (up to $4,000)

I certify that I have reviewed the PCA Tuition Reimbursement Policies and will comply with them. Upon successful application submission, I understand that I will receive emailed correspondence regarding my application, and I will need to ensure that I meet all deadlines outlined within the policy to be considered.

Scan here to visit our website and see the guidelines for Tuition Reimbursement.

SCAN HERE IF YOU NEED TO REVIW OUR POLICIES!

Confirm

Yes, I agree.

I certify that I have reviewed the Tuition Reimbursement Policies and will comply with them. Upon successful application submission, I understand that I will receive emailed correspondence regarding my application, and I will need to ensure that I meet all deadlines outlined within the policy to be considered:

**For Women and Infants Hospital (WIH) members ONLY: For ALL 2025 Semesters (FALL & WINTER 2025 INCLUDED) Women & Infants Hospital members must apply NO LATER than 11:59 pm December 15th, 2025. Any 2025 application submitted after December 15, 2025 WILL BE DENIED. NO EXCEPTIONS. After December 15, 2025 , Women and Infants Hospital members must apply by the same deadlines for submitting this online application as listed above.

Confirm

Yes, I agree.