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D&T Application
Health Development and Training Application
This application is only for those who do not require Salary Repayment. If you are requesting Salary Repayment, please print the PDF version so your Manager can sign.
Application Information
Is your employment:
(Required)
Permanent
Temporary
Casual
Probationary
Leave of Absence
If Leave of Absence, what type?
LTD
Parental Leave
WCB
Sick Leave
Other
Employee #
(Required)
First Name
(Required)
Initial
Last Name
(Required)
Home address - Street name
(Required)
City
(Required)
Postal Code
(Required)
Phone#
(Required)
Email address
(Required)
Worksite/Department
(Required)
Current Position
(Required)
Course Title
(Required)
Course Date(s)
(Required)
Pre-Registration Deadline (If there is one)
Total Amount Requesting
(Required)
Total Direct Cost
Explain your reason(s) for requesting this learning opportunity
Have you received funding from the UPSE Health Development and Training Fund this fiscal year?
Yes
No
Is this application consistent with your performance development goals?
Yes
No
Have you received and/or applied for financial assistance from any other source(s) for this specific request (including contributions from yourself, ie financial aid)?
Yes
No
If yes, indicate the amount and source of financial aid.
Checklist for application
Application completed in full
Attach description/background information of educational
Attach official receipt of payment
If official receipt not included with application, it MUST be submitted within 14 days following the start of the course
If educational is cancelled or you do not attend, all funding must be returned to the fund
Submit your receipt and course description here
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.
Date
MM slash DD slash YYYY
Signature
(Required)
