PROFESSIONAL DEVELOPMENT REIMBURSEMENT FORM

Please select your language.

This form covers Professional Development (PD) activities completed in the current year. PD activities completed in the previous year cannot be reimbursed after the December 31st of that year.

Some Professional Development activities start this year and expire next year. In this case, you can submit for reimbursement for these activities now, in this year, or wait until next year. If you submit for reimbursement after the 12/31 deadline, the funding will come from your next year's PD benefit.

Examples:

PD courses/licensure/memberships initiated in 2026 that continue into 2027 can be reimbursed using this form.
PD courses/licensure/memberships completed in 2026 and also paid for in 2026 can be reimbursed using this form
PD courses/licensure/memberships completed in 2026 but paid for in 2027 CANNOT be reimbursed using this form

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

For program details, eligibility, what activities can be reimbursed, and example documents, please visit the professional development page on our website.

The standard processing time once all standard supporting documentation received is 30 Days.

Supporting Documents are necessary before continuing:

Proof of Payment/Cost: Please submit the detailed invoice/receipt from the organization listing the total amount you paid, the goods/services you paid for, your name, the organizations name, and the date paid.
Proof of Completion: This must show that whatever activity you have paid for has been completed entirely.

Examples:
If you paid for 14 Continuing Education Units (CEUs) and submit only 2 completed CEUs we will not be able to reimburse you.
If you paid for a conference where you will obtain CEUs, we can only reimburse you after proof is provided that you obtained the CEUs.

For Study Materials/activities that are not providing CEUs directly: there is no proof of completion needed, just proof you received the materials, and proof of payment/costs. See examples here.

For Membership renewals: The Healthcare Training Fund no longer requires proof of CEUs obtained during your membership period. Your membership is still required to provide access to CEUs - but we will no longer need proof you have obtained them. See examples here.

For Licensure: You must submit documents showing proof of payment (receipt) and proof of renewal (copy/screenshot of renewed license). See examples here.

If you have any questions please email members@healthcaretrainingfund.org or call 425-255-0315. If you need help uploading documents, please visit our Help with Online Tools page.

You must have your supporting documentation ready for upload before continuing.

I have my supporting documentation ready to upload with my request

This form covers Professional Development (PD) activities completed this year. Activities completed in the previous year cannot be reimbursed after the 12/31 deadline.

Some Pprofessional Development activities start this year and expire next year. In this case, you can submit for reimbursement for these activities now, in this year, or wait until next year. If you submit for reimbursement after the 12/31 deadline, the funding will come from your next year's PD benefit.

Examples:

PD courses/licensure/memberships initiated in 2026 that continue into 2027 can be reimbursed using this form.
PD courses/licensure/memberships completed in 2026 and also paid for in 2026 can be reimbursed using this form
PD courses/licensure/memberships completed in 2026 but paid for in 2027 CANNOT be reimbursed using this form

EMPLOYEE INFORMATION: For your name please give us the full first and last name your employer has on file (no nicknames).

How did you hear about the Training Fund?

Member to Member Designee

Other referral source

First Name

Middle Initial

Last Name

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal

Address Verification

I have verified the address I have entered above is correct, and complete, including any apartment or unit number. Keep in mind that if you are requesting a reimbursement check this is the address it will be mailed to.

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

Department

Worksite Location/Campus (if not at a main hospital bldg. ex. SMC Capital Hill, VMC Kent Clinic, Lidgerwood KP, etc.)

Job Title

Bargaining Unit

Current FTE

Date of Hire (mm/dd/yyyy format)

Professional Development Activity Information

Date of Professional Development Purchase (mm/dd/yyyy format)

Type of professional development activity

Date of Completion (your activity must be completed for us to reimburse it. For any activity providing CEUs you must have completed/obtained all CEUs. For certifications or exams you must have your exam results or confirmation that you have taken the exam or obtained the certification).

Description of purchase (this would be the title of any books/courses providing CE credits, the name of the certification you earned, the name of the conference you attended, or the name of the professional membership/license you are requesting be reimbursed)

Sponsoring school or organization (this would be the name of the organization that is on the receipt whom you paid for the activity described above)

Other professional development activity

For Certification Exams/Fees - did you earn your certification

Start date of membership or certification or licensure

End date of membership or certification or licensure

Total dollar amount requested (no "$" needed, just enter in the numbers and any cents. Ex. "220.25")

No $ necessary

Lead Source

Record Type

Opportunity Name

Opportunity Stage

Contact ID

Required Supporting Documentation:

Use the guidance below to confirm that you have included the required documents with your reimbursement request. In general, your documentation should show what you paid for, how much you paid, when you paid, and—when applicable—that you attended or completed the activity.

For CEUs, Courses, and Conferences:

Please include documentation showing that you paid for the activity and attended or completed it.
Your payment documentation should include your name, the organization paid, the amount paid, and the payment date.
Please also include documentation showing that you completed the course, earned the CEUs, or attended the conference. Examples may include a CEU certificate, completion certificate, sign-in sheet, or similar record.

See examples here.

For Exams and Certifications:

Please include documentation showing that you paid for the exam or certification and completed it.
Your payment documentation should include your name, the organization paid, the amount paid, and the payment date.
You may request reimbursement for exam costs whether you passed or did not pass.

See examples here.

For Study or Review Materials:

Please include payment documentation for the study or review materials you purchased.
The documentation should include your name, the item purchased, the amount paid, and enough detail to show what the purchase was for if it is not clear from the title of the materials.

See examples here.

For Professional Memberships:

Please include payment documentation for your professional membership.
The documentation should show that the membership is in your name and include the organization paid, the amount paid, and the payment date.
Important: If the Training Fund paid for this same professional membership in a prior year, please also include proof that you completed CE activity with that organization before requesting reimbursement again.

See examples here.

For Professional Licensure Fees:

Please include documentation showing that you paid the professional licensure fee and renewed your license.
Your documentation should include proof of payment and a copy of your license information showing the renewal.

See examples here.

Supporting Documentation

After you submit the form, within a few minutes, you will receive an email from Heathcare Training Fund via Conga Sign (please check you junk/spam for this). That email has a blue 'View Document' button to click at which point you will begin the electronic signing process. Click here for a walkthrough of the signing process you can review.

Under penalty of perjury, I state that the information provided is correct. By signing this form, I approve the Healthcare Training Fund to issue funding on my behalf.

Page 5

PRIVACY POLICY

• https://healthcaretrainingfund.org/privacy-policy/

• Please Note that in completing the attached "Application," you are also agreeing to the following statement:

I have had the opportunity to read and review the Healthcare Training Fund Privacy Policy. By filling out and submitting this Application/Intake Form, I agree to this Privacy Policy and authorize the

Healthcare Training Fund to contact, or my behalf, current or previous employers or educational institutions, or other relevant entities, to obtain information that may be necessary for the administration of the Healthcare Training Fund's benefits. I further understand this authorization is on-going for the purposes of administering the Healthcare Training Fund's benefits.

I agree

DATA SHARING WITH LABOR MANAGEMENT PARTNERS

The Healthcare Training Fund provides specific details about active members' usage of Healthcare Training Fund programs and services to both employer and labor partners. Sharing this information allows labor/management partners to do more targeted workforce planning, and also support individuals in their career and programmatic path. Data that we share does not include Social Security Number. Your information may be shared with grant issuers.

Do you agree to allow the Healthcare Training Fund to share your information with employer partners:

Do you agree to allow the Healthcare Training Fund to share your information with SEIU Healthcare 1199NW:

TEXT MESSAGING 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 members about their education and training benefits and services. Standard text messaging rates apply.

By completing this form, you authorize text messaging from Healthcare Training Fund unless you decline text messaging. To decline Text Messages, email your Regional Education Navigator or members@healthcaretrainingfund.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 Navigator (if you don’t have one, one will be assigned on submittal of this form) if you have questions on text messaging.

Permission to Text (Optional) I consent to receive Conversations (external) text messages from Healthcare Training Fund. Reply STOP to opt-out; Reply HELP for support; Message and data rates apply; Messaging frequency may vary. Visit https://healthcaretrainingfund.org/privacy-policy/

for privacy policy and https://healthcaretrainingfund.org/training-fund-sms-terms-of-use/ for Terms of Service.

By checking this box, you agree to receive SMS messages from Healthcare Training Fund related to (SMS Use Case). You may reply STOP to opt-out at any time. Reply HELP for assistance. Messages and data rates may apply. Message frequency will vary. Learn more on our privacy policy page and Term & Conditions.

PHOTO/VIDEO USE POLICY – HEALTHCARE TRAINING FUND EVENTS

The ability to communicate about Healthcare Training Fund services to our members and to use information gathered in classes and sessions for further training is important to the Healthcare Training Fund.

Unless you decline photo/video by Healthcare Training Fund, by completing this form you authorize and agree that the Healthcare Training Fund and SEIU Healthcare 1199NW may use photographic images or video footage of you, or in which you are included, taken during Healthcare 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 Regional Education Navigator or members@healthcaretrainingfund.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 Navigator (if you don’t have one, one will be assigned on submittal of this form) if you have questions on photo/video use.

NON-DISCRIMINATION POLICY STATEMENT

The Healthcare 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.