Education Reimbursement Application

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.
Individuals can submit a reimbursement application anytime before or during their coursework.

Application and all documentation must be submitted within 30 days of course completion.

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 ReimbursementI have not received any disciplinary action in the past six monthsI agree to remain employed with IMH for at least 12 months after completing the course or certificationCourse/certification directly benefits IMHThe education program is offered by an accredited school, program, or professional associationThis request is not for a license, certification, or recertification required for my current positionMy request covers only eligible tuition or certification costs (not including books, conferences, or other supplies)I will submit this application and proof of payment within 30 days of completing the courseI understand that completing a course does not guarantee reimbursement if policy criteria are not met
Name*

First NameLast Name
Email*
Please check this email for communication regarding your application

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*
Hire Date*

MonthDayYear
Department*
Current Job Title*
Certification/Course Name*
If your program extends beyond one term, a separate reimbursement request is required for each term.
School/Institution Offering Education*
Example: University of Wyoming, LCCC, ANCC
What Certification/Degree are you working towards?*
Note: Education that does not work towards or result in a degree/certification is ineligible.
Upload Certification/Course Documentation*

Browse Files
Ex: Certification Completion, Course Description, Course Schedule, Final Grades Cancelof
Certification/Course Start Date*

MonthDayYear
Certification/Course End Date*

MonthDayYear
Anticipated Cost*
How do you plan to pay for your education?*

In Full (Out of Pocket)Student LoansPayment PlanOther
Payment and Documentation Requirements

Proof of payment is required to receive reimbursement.
- If you are using a payment plan, you may submit documentation for partial reimbursement once you provide a copy of your payment plan schedule and proof of payments made to date.
- Reimbursement can only be processed once clear documentation of payment or payment arrangements is submitted.
- All documentation, including proof of payment and final grades or completion verification, must be submitted within 30 days of course completion.
Upload Receipt / Payment Documentation

Browse Files

Cancelof
I agree to stay employed with Ivinson Memorial Hospital for at least one year (12 months) after finishing my course or certification. If I leave earlier, I understand that I may need to repay part of the reimbursement based on how long I stayed after completion.*

I agree
Should be Empty:

Education Reimbursement Application

Payment and Documentation Requirements