Professional Development Stipend Reimbursement Form (2025-26)
Full Name
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First Name
Last Name
E-mail
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Your E-mail Address
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Key details to note:
Submission of receipt does not guarantee reimbursement.
Please make one submission for each reimbursement request.
Staff will review for eligibility (refer to website landing page for details).
Ensure you include a PAID receipt/invoice for your reimbursement request (bank statements are not accepted). If you paid in non CAD currency, please include a screenshot of the credit card transaction so you're reimbursed for the full CAD amount you paid. Otherwise, MABC Accounts will use the exchange rate on the day
Submission information
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Rows
Amount
Category
Description
Date
Details:
Conference (in person)
Conference (online)
Course (in person)
Course (online)
Subscription
Textbook
Other
Cultural Safety Training
Trauma Informed Care
Spinning Babies workshop
Surgical First Assist
Lactation/ Breastfeeding course
Contraception
Pelvic and Perineal healthcare
Other
Please provide additional details about the course
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If you attended a conference, did you PRESENT at the conference?
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Yes
No
Not applicable
Proof of Purchase (paid receipt/ invoice)
*
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Total Reimbursement request ($)
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Total Reimbursment request ($)
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$
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I certify that all information entered above is valid and true.
I attest that I have not submitted this expense reimbursement request with another committee, health authority, or organization.
This submission pertains to course(s) that were completed or will be completed in this Fiscal year (April 1, 2025-March 31, 2026).
I understand that MABC may request additional documentation to support my claim.
Please verify that you are human
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