Request for Financial Support of Training, Membership, or Certification

Please complete the survey below to request financial support. Financial support is available to members of Re LAB's Strengthening Forensic Nursing Program. To be awarded reimbursement, members must have completed the annual member survey and submitted their NPI.

Please note that Re LAB is not able to provide financial support for the IAFN Conference in August 2025.

Pending budgetary availability, Re LAB provides reimbursement for trainings and events that will help you grow in your practice as a SANE. We may also provide reimbursement for IAFN membership (national and state) as well as for the SANE certification exam and related costs.

Please submit one survey per reimbursement request. Review complete information about the reimbursement process here.

First Name*

Last Name*

Email*

NPI (National Provider Identifier)*

Due to the reporting requirements of our funder, HRSA, we must submit the NPI numbers for each trainee provided reimbursement support. Please see here for more information about the process to get an NPI if you do not yet have one.

If you would like more information about what reimbursement Re LAB may be able to offer before getting an NPI and submitting a reimbursement request, please reach out to relab@umn.edu.

Are you practicing as a SANE now or in the past 12 months?*

Yes

Name Of Training*

Select

Name Of Training (Other): Please provide the name of the training*

Name of Organization Providing Training*

Training Format*

In-person

Online

Location Of Training*

Date(s) Of Training, Membership, or Certification*

Who will be paying for this training?*

Select

What employer is funding the training?*

Cost of opportunity excluding travel/lodging expenses:*

How do you think this opportunity will help you as a SANE?*

Re LAB can provide travel support if members are travelling 50 miles or more (one-way) for the training. Specific travel support depends on the distance travelled--see Re LAB Travel Support Guidelines.

How far are you traveling one-way for the training?*

Select

Are you requesting travel support?*

(Please see eligibility requirements above.)

Select

Agree To Terms*

I understand trainings must be approved in advance for reimbursement by program staff. I understand reimbursements are processed after training is complete and all components of reimbursement must be submitted to the UMN's secure platform, UMN Box, within 30 days of the training.

I agree to submit:

Proof of payment: a receipt that shows payment received for training and preferably includes the training date. A cancelled check, bank or credit card screenshot is not acceptable.
Proof of completion: a CEU certificate or similar document

AND

If your employer has paid for the training, the program will reimburse your employer for that expense. Please provide a completed copy of the organization's W-9 form.

If you have paid for the training, the program will reimburse your expense. Please provide a signed copy of your W-9 form.

Yes

Send me a copy of my responses

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