2023 Scholarship Application for the Washington Foundation for LTC

The Washington Foundation for Long Term Care awards scholarships for higher education at a college, university, technical college, or other higher education learning institute to individuals who work in a WHCA-member facility. Scholarship checks are made payable to the recipient and the college or institution where enrolled. Scholarships may not be used for classes or workshops that do not provide college credit toward a degree program. Complete scholarship application packets include the application and two letters of recommendation. Incomplete applications will not be submitted to the Selection Committee. Applications and two letters of recommendation are due on or before Friday, March 24, 2023.

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* 1. Applicant Information

Name

Mailing/Street Address (where we would send a check)

City

State

Zip

Telephone Number

Facility Where You Work

Current Position/Title

Facility Street Address

Facility City, State, Zip

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* 2. Please indicate your present employment status.

Employed Full Time (at least 35 hours per week)

Employed Part Time (less than 35 hours per week)

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* 3. How long have you been employed by the facility?

Less than 1 year

1-3 years

4-5 years

5 or more years

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* 4. What degree are you hoping to earn?

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* 5. Have you been accepted in a training program for the degree you are hoping to earn?

Yes

Not sure yet

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* 6. What is the name and location of the college or university you currently attend or are planning to attend?

Currently attending institution listed below

Not currently attending

College or University (Name and City, State):

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* 7. When is your expected date of graduation?

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* 8. What is your highest level of education earned so far?

Have not graduated from high school

High School Graduate or GED

2 year College Degree

4 year College Degree

4 year College Degree earned plus additional study

Please list any additional college degrees held

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* 9. What are other types of formal education, such as facility training/certification programs (example: Nurse Aide Certification Program) you have completed?

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* 10. Describing your current financial needs, please tell us what impact the LTC Foundation scholarship may have for you?

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* 11. Please estimate the annual cost of study in your field (include tuition, fees, books, etc.):

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* 12. Please list your employment positions (including summer and part time positions) for the past five years beginning with the present.

Present employer

Past

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* 13. Please describe your interest in long term care, commenting on your involvement to date in assisted living community, enhanced services facility and/or skilled nursing facility settings:

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* 14. How have you personally and/or professionally benefited from your experiences in long term care and what unique challenges do you believe this field holds?

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* 15. Describe three career goals and how you plan to accomplish them.

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* 16. By checking "Yes" and submitting this application, you certify that all information contained herein is true and correct. All Foundation scholarship nominees are required to request and submit two letters of recommendation to complete the application packet by March 24, 2023.

Yes

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* 17. Please provide the name and email address of 2 individuals who will provide letters of recommendation. The Washington Foundation for Long Term Care will contact these individuals and provide the link to submit. The due date for the letters of recommendation is Friday, March 24, 2023. Please be sure to touch base with those you listed as contacts. Thank you!

Contact 1 Name *

Contact 1 Email

Contact 2 Name

Contact 2 Email