Ed Fund Application (2025-2026) "*" indicates required fields Step 1 of 8 12% For the period of July 1, 2025 – June 30, 2026Effective July 1, 2025 – June 30, 2026 (unless otherwise approved/posted by the Education Fund Committee), PEINU Members will be eligible for a combined total reimbursement of up to $2500 from the Education Fund. This new amount includes both the “Direct Costs” and/or the “Salary Compensation Costs” which can be used at the discretion of the member. (Previously, members were eligible for up to $2200)Important TimelinesApplications will not be accepted more than 90 days prior to the start date of the Education Activity, or more than 10 business days after the Start Date of the Education Activity. Applications received outside of these time limits will not be processed or approved. (For Masters programs, Applications must be received no later than 10 business days after the first payment date.) Contact the Ed Fund AdministratorIf you have any questions please contact the Education Fund Administrator at EdFund@peinu.com or call the PEINU Office at 902-892-7152 to leave a message.PEINU Member Eligibility CriteriaApplicants must be Active Members of the PEI Nurses’ Union at the time of their application and on the Date(s) of the Educational Activity.Applicant InformationName of Applicant* First Last Health PEI Employee #*Email*Pre-approval letters and communications with the PEINU Ed Fund Administrator will be sent by email. Daytime Phone/Voicemail* Eligible MembersAre you currently an Active (Dues Paying) Member of PEINU?*ie: you paid dues in the last pay period Yes No I don’t know If you did NOT pay dues in the last pay period, please select one of the following statements: I am a Casual Employee and I have worked/paid dues in the last 3 months. I am a Casual Employee and I have NOT worked/paid dues in the last 3 months. I am on an approved “General” Leave of Absence for less than 3 months. I am on an approved “General” Leave of Absence for more than 3 months. I am on an approved Leave of Absence for other reasons (ie: Sick, Education, Maternity/Parental, etc.) Other Do you hold (or work in) an Excluded Position with Health PEI?* Yes No Have you submitted any other applications to the Ed Fund between July 1 – June 30th?*Individual applicants are responsible for keeping a record of the funding they receive throughout the fiscal year (July 1 2025-June 30, 2026). Yes No Have you submitted an application to the Ed Fund for this same course in the past?* Yes No Details of the Educational ActivityIs this application for funding related to enrollment in a Post-Secondary or Post-Graduate program?* Yes No Educational Activity or Program Name:*Presented / Offered By:*Location*PEI Nurses Union Event SiteHealth PEI Work Site or Event SiteOnline ActivityUPEIHolland CollegeOtherPlease Specifyie: Where is the educational activity taking place?Start Date*ie: When do you anticipate that you will participate in the educational activity? MM slash DD slash YYYY Is there an attendance requirement:* Yes – Attendance is Required for this Education Activity No – This Education Activity is Self-Directed Attendance Requirement (In-Person or Virtual) vs. Self-Directed LearningWebsite: (if applicable)When is the deadline for payment?Applications for funding for Post-Secondary courses must be received no later than 10 working days beyond the first payment due date. MM slash DD slash YYYY Is this Educational Activity considered a mandatory course, required orientation, or training needed to work to full scope in your current position?* Yes No I’m unsure Employment InformationEmployment Status with Health PEI* Permanent Temporary Casual Guaranteed Hours with Health PEI Full-Time Part-Time What is your % FTE?Please enter a number from 1 to 100.Enter a whole number between 1-100 (100 = Full-Time)Are you scheduled for 8-hour or 12-hour shifts?Please enter a number from 8 to 12.Use the whole number “8” or “12” onlyYears of Service with Health PEI 1 Year or MORE (as of July 1) LESS than 1 Year (as of July 1) For Casual Employees with 1 Year or MORE of Service (as of July 1st) please indicate how many hours of service you had in the last fiscal year (July 1, 2024 to June 30, 2025):Less than 100 hoursBetween 100 hours to less than 300 hoursBetween 300 hours to less than 500 hours500 hours or moreI have less than one year of serviceFor Casual Employees with LESS than 1 Year of Service (as of July 1st) please indicate how many hours of service you have in the current fiscal year (July 1, 2024 to June 30, 2025):Less than 100 hoursBetween 100 hours to less than 300 hoursBetween 300 hours to less than 500 hours500 hours or moreIhave more than one year of serviceWork Site*Where is your primary worksite?Work Unit*What is your primary work unit?Position Title*Example: Float Nurse, General Duty / Staff Nurse, Clinical Lead, Clinical Educator, LTC Supervisor, etc.Classification* RN 1 RN 2 RN 3 RN 4 NP GN (Provisional Class / New Grad RN) GNP I don’t know Your Classification & Step determine your rate of pay. Step* Step 1 (0-1 Years) Step 2 (1-2 Years) Step 3 (2-3 Years) Step 4 (3-4 Years) Step 5 (4-5 Years) Step 6 (5+ Years) 10-Year Wage Rate 15-Year Wage Rate The “Step” is based on your Hours of Service and determines your wage rate. (1 Year FTE Hrs = 1950 Hours of Service)What is your current wage rate? ($)*Please enter a number from 38.51 to 68.24.Per Appendix “A” of the Collective Agreement Application for Direct CostsEffective July 1, 2025 – June 30, 2026 (unless otherwise approved by the Education Fund Committee), PEINU Members will be eligible for a combined total reimbursement of up to $2500 from the Education Fund. This amount includes both the “Direct Costs” and/or the “Salary Compensation Costs”. Please select the types of Direct Costs that will be included on your application/claim:* Registration Fee Materials & Textbooks Other Select AllRegistration Fees ($)Please enter a number less than or equal to 2500.Materials & Required Textbooks ($)Please enter a number less than or equal to 2500.Other Costs ($)Please enter a number less than or equal to 2500.Other (Please Describe)Travel expenses are not eligible for reimbursement.Total Amount of Direct Costs ($)Total of the Registration Fees, Materials & Required Textbooks, and Other Costs that are entered above. Online ClaimsClaims must be submitted through the online form. (Claims submitted by fax will not be accepted for new applications.) Have you already paid for the Direct Costs included on this application? Yes – I have already paid for the Direct Costs. No – I have not paid for the Direct Costs yet. Receipt (01)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 1 GB. Receipt (02)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 1 GB. Receipt (03)Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 1 GB. REMINDER: Deadline to Submit ReceiptsReceipts must be submitted within 60 days of completion of the educational activity. Receipts submitted after more than 60-days will not be eligible for reimbursement.REMINDER: Deadline to Submit Receipts for Online EducationFor online courses, receipts must be submitted within 60 days of the *Start Date* of the course. Receipts submitted after more than 60-days will not be eligible for reimbursement.REMINDER: Deadline to Submit Receipts for Post-Secondary & Post-Graduate Courses/ProgramsFor post-secondary and post-graduate courses/programs, receipts must be submitted within 10 days of the first payment deadline. Receipts submitted more than 10-days after the first payment deadline will not be eligible for reimbursement.Salary Compensation CostsWould you like to submit an application for Salary Compensation Costs? Yes No Applications for Salary Compensation CostsEffective July 1, 2025 – June 30, 2026 (unless otherwise approved by the Education Fund Committee), PEINU Members will be eligible for a combined total reimbursement of up to $2500 from the Education Fund. This amount includes both the “Direct Costs” and/or the “Salary Compensation Costs”. I understand that it is my responsibility to:* provide my Nurse Manager with a copy of the Ed Fund Pre-Approval Letter that will be provided to me by the PEINU Ed Fund Administrator. How many days are you required to attend this Education Activity?Please enter a number from 1 to 365.Enter the whole number of calendar daysDaily Attendance Requirement: Attendance required for 4 hours or less Attendance required for more than 4 hours, up to 8 hours Attendance required for more than 8 hours What are the actual hours (total) required to participate in the Education Activity?*Actual Hours of Participation in the Educational Activity (or the # of hours that you wish to include for this application, whichever is less)Maximum Additional Hours of Salary Compensation for Education Leave:Based on your entries, you may be eligible for Salary Compensation Costs to cover additional hours of Education Leave that may be required to attend the Education Activity. Additional hours are only applicable to cover hours that you are scheduled to work. They cannot be banked as TIL. The maximum additional hours are included here:How many Additional Hours do you wish to include on this application? (if any)Up to the Maximum Additional Hours identified above.Estimate of Salary Compensation Costs ($)Estimate of the costs of your wages & benefits, based on your entries for the Actual Hours of Participation, Additional Hours (if applicable) and your current Wage Rate.Your Responsibility to Share the Pre-Approval LetterSalary Compensation is Subject to Fulfillment of Responsibilities for Documentation & Deadlines* I understand that it is my responsibility to provide the Employer (my Nurse Manager) with a copy of the Ed Fund Pre-Approval Letter in order to be eligible for Salary Compensation that I have requested in this application. Acknowledgement of Risk* I understand that I may become ineligible for Salary Compensation if I fail to submit the required documentation (on time) to the Employer and/or Ed Fund Administrator. Your Application for FundingThe application for funding that you are submitting is displayed below as the “Total Amount (Estimate) of My Ed Fund Application”.Total Amount (Estimate) of My Ed Fund Application:*This includes the Total Amount of Direct Costs and the Estimate of Salary Compensation Costs, if applicable.Application for Funding in excess of $2500PEINU Members are eligible for a maximum, combined total reimbursement of $2500 for approved educational activities. If your application is approved, the Ed Fund Administrator will provide additional information about the portion(s) of the Direct Costs & Salary Compensation that would be reimbursed by the Ed Fund.Submitting the FormFields indicated with “*” are required and must be completed before the form will submit successfully. Please review the information you have provided prior to submission. Once you are satisfied with the information included on the form, click “Submit”. Disclosure Statement* I hereby certify that the information provided is true and accurate to the best of my knowledge. I understand that a false statement or claim may disqualify me from funding and that I will be responsible for the associated expenses. Δ
