Professional Development Award Application Company Name * Please provide Membership Category Level Name of Representative Submitting Application Title First Name * Last Name * Suffix APPLICATION FOR REIMBURSEMENT Please complete the following requested information for reimbursement. Purpose for Reimbursement * Training Certification Leadership Development Other * If Other, please specify below. If you selected other, please specify below. * One application per quarter, per member. Members are limited to the number of allotted representatives based on membership category. For example, if you are a Category C ($1,000 Dues) with an allotment of 3 representatives, you can get coverage for up to three employees per application. Members may submit applications for up to $250 in reimbursements. An application must be made for workforce development completed or to be completed one month prior or in advance of the applied quarter. Required Documents: Proof of Training/Certification * Must provide proof of completion and payment. Date and Time Format: M/d/yyyy