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 $2500 per calendar year, as funding allows. Please review eligibility requirements and application details below. For courses, please complete the application on a semester/term basis.
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 12 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 guarentee reimbursement if policy criteria is not met
Name
*
First Name
Last Name
Ivinson Email
*
example@ivinsonhospital.org
FTE
Max Annual
Reimbursement
1.0 - 0.8
$2,500
0.7 - 0.6
$1,250
Under 0.6
$750
Current FTE
*
0.8 to 1.0 FTE
0.6 to 0.7 FTE
Below .6
Hire Date
*
-
Month
-
Day
Year
Department
*
Current Job Title:
*
Certification/Course Name
*
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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