Education Reimbursement Application
Ivinson's Education Reimbursement Program was created to support the continuing education of Ivinson employees. Employees are eligible to receive up to $5,000 per calendar year, as funding allows. Please review eligibility requirements and application details below.
Review the Education Reimbursement Policy
HERE
Eligibility: To receive education reimbursement, you must meet/agree to all of the following requirements at the time of reimbursement.
*
I have reviewed and agree to IMH Policy HW120 Education Reimbursement
I have not received disciplinary action in the last 6 months
I agree to continue employment with IMH for at least 12 months following certification/course completion
Course/certification directly benefits IMH
Education is provided by an accredited school, program, or association
This education is NOT for licenses, certifications, or recertifications required by my current position
My request will cover eligible tuition, certification, and/or recertification fees (conferences, books, and other supplies are not eligible)
I agree to submit this application and proof of receipt within 30 days of satisfactory completion
I understand that completion of course does not guarantee reimbursement if policy criteria is not met
Name
*
First Name
Last Name
Ivinson Email
*
example@ivinsonhospital.org
FTE
Hours per pay period
Max Annual
Reimbursement
0.8 - 1.0
64 - 80
$5,000
0.6 - 0.7
48 - 56
$2,500
0.1 - 0.5
8 - 40
$1,500
Current FTE
*
0.8 to 1.0 FTE
0.6 to 0.7 FTE
0.1 to 0.5 FTE
Hire Date
*
-
Month
-
Day
Year
Department
*
Current Job Title:
*
Certification/Course Name
*
For courses, please complete the application on a semester/term basis.
School/Institution offering education:
*
Example: University of Wyoming, LCCC, ANCC
What will completion of this education accomplish?
*
Ex: Certification, Working towards Master's
Upload Certification/Course Description, Documentation, etc.
*
Browse Files
Cancel
of
Certification/Course Start Date
*
-
Month
-
Day
Year
Certification/Course End Date
*
-
Month
-
Day
Year
Anticipated Cost
*
I commit to continue my employment with Ivinson Memorial Hospital for no less than twelve (12) months following certification/course completion. I understand that if I fail to meet any of the aforementioned eligibility requirements, I will be required to repay Ivinson Memorial Hospital an amount pro-rated by months worked since certification/course completion.
*
I agree
Submit
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