EmailMe Form - Volunteer Services Education Reimbursement Request

Qualifications for Reimbursement for Continuing Education Class:

We have the right to deny any request that does not meet the qualification for reimbursement.

* Minimum of twelve continuous months and a minimum of 100 active volunteer service hours.

*Currently active at WakeMed Raleigh Campus or North Hospital at the time of class completion.

*Appropriate course provider & content.

*Requests for reimbursement must be received within ten (10) days of class completion.

*Participants are required to fill out a short survey on their continuing education course or program to aid in committee planning.

Qualified volunteers will be reimbursed for costs up to $200 per continuing education class or seminar completed. Some examples of appropriate classes would be Basic Life Support, Mental Health First Aid, customer service, language, and leadership development courses, among others.
Contact Person *
First Last
Email *
Telephone Number
### - ### - ####
Mailing Address *

Street Address City State / Province / Region Postal / Zip Code
1. Where was your Continuing Education Class Taken: *
WakeMed
WakeTech
NC State
Raleigh Parks & Recreation
Other *(complete question #2)
2. If selected other other in question #1. Where did you take your class:
3. Type of Continuing Education Class *
Leadership Development
Second Language
Basic Life Support
First Aid
Behavior and Mental Health
Other *( complete question #4)
4. If selected other other in question #3. What type of class did you take:
5. What was the format of the class? *
In-Person
Virtual
Hybrid (virtual and in-person)
6. Start Date of Class *
MM / DD / YYYY
7. End Date of Class *
MM / DD / YYYY
8. Title of Continuing Education Class *
9. Provides us with a description of the Continuing Education Class: *
10. What was your goal for taking the class: *
11. Did you earn a certification as a result of taking the class? *
BLS Certificate
Computer Certification
Leadership Development Certification
Lanaguage Certification
Other (complete question #12)
12. If selected other other in question #11. What did you earn at the completion of class:

13. Evaluate the following statements. *

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
Would you recommend this course to other volunteers?
Would you recommend this provider to other volunteers?
Did the course content match the course description?
Was the course registration process clear and easy to complete?
Did the facility where the course was held meet your expectations and needs?

14. Please share any comments you may have on your completed course
15. Upload Proof of Completion of class/course, Copy of Supporting Documentation and Receipts of Course Payment: *

Add File

Supporting Documents are: receipt of course payment, copy of certification, syllabus or course description or any documentation received after completion of course.

Qualifications for Reimbursement for Continuing Education Class: