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FutureCare NC Certified Nursing Assistant Scholarship Application
1.
Applicant Contact Information
Name
Facility
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
*
2.
In a 400 - 500-word essay, describe/explain why you want to be a Certified Nursing Assistant. What would you like or hope to accomplish during your nursing career.
(Required.)
3.
Are you currently accepted into a Certified Nursing Assistant program?
Yes
No
4.
If the answer to question #2 is "Yes", what is the name of the program?
5.
Have you been employed at a North Carolina Health Care Facilities Association member facility for at least nine months?
Yes
No
6.
Do you agree to remain employed at a North Carolina Health Care Facilities Association member facility for at least 12 months after certification?
Yes
No
7.
Each scholarship applicant must submit at least three Letters of Recommendation (emailed to
erick@nchcfa.org
) with 1 of the required letters from the applicants SNF Supervisor. Please share with us the names of who will be submitting your Letters of Recommendation.
SNF Supervisor
Other
Other