Tuition-travel Reimbursement Application

Before completing this form, read the Tuition/Travel Reimbursement Policy, contact the Executive Director if you have questions.

Tuition-travel Reimbursement Policy

Oregon Simulation Alliance Sponsored Education And Training Reimbursement Program
Candidates can apply for reimbursement for simulation related program or conference, travel and lodging fees for training programs sponsored by the Oregon Simulation Alliance and/or conferences held locally or nationally. The selection criteria for the distribution of available funds reflect the philosophy that simulation programs/coalitions will commit to and financially support the development of simulation specialists and the sustainability of individual programs.

In an effort to distribute the funds across the state and to as many individuals and coalitions as possible, the Governing Council of the OSA will determine the maximum amount that will be funded to an individual.
As part of the application process, the applicant will itemize their expected expenses and the maximum amount that will be awarded will be 50% of the expected expenses or up to $750.00 in this funding round, whichever is the least amount. Under a limited number of special circumstances, individuals may be considered for reimbursement that exceeds the $750 limit.

The application deadline for reimbursement is two weeks prior to scheduled training. Funds will be distributed within four weeks upon submission of receipts and the After-Conference/Program Report.

I understand and read the Policy: *

yes

Personal Info

First Name: *

Last Name: *

Mailing Address: *

Phone: *

Email: *

Professional Info

Credentials (Ex: MD,RN,EMT-I): *

Position Currently: *

OSA Affiliation (facility, educational institution, agency, public, etc): *

Program

Name of conference/program planning to attend: *

Location of conference/program: *

Date(s) of the program: *

Describe how attending the conference/program will allow you to advance the work and goals or your represented : *

Describe how attending the conference/program will allow you to advance the work and goals or your represented institution/organization and the OSA.

Reimbusement Request

All items in this section MUST be answered. If not applicable, please place an NA in the space.

Have you been reimbursed by the OSA for expenses in the past?: *

yes

If yes, When were you awarded funds?:

How much did you receive?:

Did your employer or local sim coalition pay your salary for the previous times you spent in training: *

yes

Itemized conference/program fees (estimate): *

Itemized travel fees (estimate): *

Itemized lodging fees (estimate): *

Total cost (estimate): *

The distributed funds fromthe OSA will vary depending on the current funding sources. For this particular funding round the amount each applicant can be awarded is up to $750.00 or half of the total cost, which ever is the smaller amount. On rare occassions amounts greater than $750.00 may be granted. If you believe your situation merits such consideration, submit a one page summary expaining your circumstnaces, eligibility, and amount requested to the OSA Executive Director.

Is your simulation program affiliation or employer willing/able to reimbuse you for the remaining cost?: *

yes

Search

Oregon Simulation Alliance

Tuition-travel Reimbursement Application