MiFi Mobile Hotspot Request Form

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

The Training Fund has mobile hotspots available to support eligible members who have limited Internet connectivity. To request one to support your academic and job training needs, please fill out this form.

The duration of the hotspot loan is not intended to exceed 90 days or approved Training Fund program. Extensions may be granted for one term (or 90 days for short-term programs). Training Fund staff will work with you to overcome barriers and create a plan for a permanent solution.

At the conclusion of the program, the hotspot will need to be returned to Eduscape.

These hotspots are provided by our partner, Eduscape. After submitting this form, our staff will review your eligibility and contact you if we have questions. Requests are fulfilled on a first come first serve basis, availability is not guaranteed.

If your request is approved, Eduscape will ship you a device. Orders are processed by our partner every Tuesday and Thursday with shipping being roughly five business days. We will let you know when we have submitted your order and have a tracking number.

On the next page you'll give us your contact information, where to send the MiFi mobile hotspot, and how long you intend to use it. Let's get you started by clicking 'Next Page' below!

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

Contact Information

First Name

Middle Initial

Last Name

Your Home Address for Shipping

Address (Including apartment or building number)

City

State

Postal Code

Is your home address OK to ship a MiFi mobile hotspot to?

YesNo, I'd rather you ship it to a different location

Tell us where you would like it to be ship to (could be a school or work location). Provide the full and complete address.

Any special instructions for delivery?

Preferred Phone Number

Mobile Phone

Home Phone

Work Phone

May we text you? Message and data rates from your carrier would apply.

Preferred 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. You can use your work email if you don't have a personal email.)

Eduscape, our partner, would like to be sure they have a personal email on file for you in order to send you instructions and updates on your MiFi request. Please give us a personal email as well.

Employer

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

Lead Source

Record Type

Use Information

Start Date of MiFi Use

General End Date of MiFi Use

General Use Purpose

Tell us a little bit about why you need a mobile hotspot device.

Contact Information