2019 Foundation Scholarship Application Form

QUALIFICATIONS

An applicant must be an employee who has worked in a GHCA-member skilled nursing care center for at least the past year;
An applicant must be enrolled in or accepted into an accredited program of study in a selected field;
An applicant must be recommended by the Administrator and the Director of Nursing of the skilled nursing care center where they are employed;
An applicant must be an individual who pledges to maintain employment in a skilled nursing care center and hold either a full-time or part-time position while attending school; and,
Scholarship recipients will agree to work in the skilled nursing care center of their choice for a period of one year following completion of their course of studies.

The deadline to submit the Georgia Health Care Association Education & Research Foundation Scholarship Application Form is May 20, 2019.

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* 1. First Name

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* 2. Last Name

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* 3. Address 1

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* 4. Address 2

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* 5. City

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* 6. State

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* 7. Zip

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* 8. Phone

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* 9. Email

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* 10. Name of GHCA member center where you work

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* 11. Work Address Line 1

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* 12. Work Address Line 2

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* 13. City

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* 14. State

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* 15. Zip

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* 16. Work Phone

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* 17. Administrator First Name

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* 18. Administrator Last Name

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* 19. Administrator Email

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* 20. Dates of Employment

From

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* 21. College/Institution where you have been accepted

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* 22. Student ID #

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* 23. City of college/institution where you have been accepted

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* 24. Contact Information for above college/institution

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* 25. Name of major/degree program

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* 26. Date by which you expect to complete your studies

IMPORTANT - Please attach the following additional information to your application form:

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* 27. A letter of explanation from the applicant outlining why he/she is interested in a career in Nursing (limit: one page);

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