Certified Nursing Assistant/Home Health Aid Scholarship

Student Demographic Information

Full Name *

Current Mailing Address *

City *

State *

Postal code *

Phone *

Email *

Are you legally authorized to work in the United States *

Yes

High School Attended *

Did you graduate from high school? *

Yes

Did you attend college or vocational school? *

Yes

Did you graduate from college or vocational school? *

Yes

Not Applicable

If yes, where did you attend college or vocational school? *Specify name of program and level of education or certification reached.

Financial Need Statement

Do you attest that you have a financial need for this scholarship, meaning that you have no other means of paying for tuition such as other grants, scholarships, awards, educational savings, etc.?

Yes, I attest I have a financial need.

Initial Here *

In your own words, please describe why you wish to be awarded this scholarship including any special circumstances in your past or any work experience that may influence the scholarship committee. Please not here any work you have performed in home health or home care, if applicable. *

Employment History

Are you currently employed? *

Yes

If yes, please give your employment history below (Dates of Employment, employer, position, and reason for living). *

Certification/Reference Letter

All applicants must submit at least 1 and up to 2 reference letters with this application. The letter can come from a high school counselor or teacher, a manager who works in home health or homecare, or a current or previous employer. Please submit this letter(s) at the end of this application package.

File Upload

Please give the name(s) and contact information for the person providing your letter.

Reference 1

Reference 2

Please answer the following questions.

1. Are you willing to work as a Certified Nursing Assistant/Home Health Aide for at least one year upon completion of training? *

Yes

2. Did you review the background requirements to enroll in C.N.A/HHA training in CA and do you meet those requirements? *

Yes

3. Have you enrolled in a C.N.A./HHA vocational program? *

Yes

4. Which C.N.A/HHA vocational program do you wish to attend? *

5. What is the full tuition of the program you plan to attend? *

Certification Statement

I hereby certify that the information I have provided on this application form and any attached materials is true and correct.

Applicants Legal Signature *

Clear

Date *