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2026 Lucy M. Rogers Nurse Scholarship Application Form

QUALIFICATIONS
  • Applicant must have been employed by a GHCA member provider (SNF, ALF, SOURCE/CCSP) for one year
  • Applicant must be recommended by the Administrator/Executive Director and Director of Nursing/Clinical Supervisor
  • Applicant must be accepted into the nursing program
  • Commit to part-time or full-time employment while attending school
  • Remain employed in the GHCA member provider setting of their choice for one year post-graduation
The deadline to submit the Georgia Health Care Association Education & Research Foundation Scholarship Application Form is May 29, 2026. Please note that incomplete applications will not be considered.
1.First Name(Required.)
2.Last Name(Required.)
Please enter the following for your personal home address information.
3.Home Address 1(Required.)
4.Home Address 2
5.City(Required.)
6.State(Required.)
7.Zip(Required.)
8.Phone(Required.)
9.Personal Email(Required.)
10.Name of GHCA member SNF/ALF/SOURCE agency where you work(Required.)
Please enter the following for your work address information.
11.Work Address Line 1(Required.)
12.Work Address Line 2(Required.)
13.City(Required.)
14.State(Required.)
15.Zip(Required.)
16.Work Phone(Required.)
17.Administrator First Name(Required.)
18.Administrator Last Name(Required.)
19.Administrator Email(Required.)
20.Dates of Employment(Required.)
21.College/Institution where you have been accepted(Required.)
22.If awarded scholarship, entity check should be made payable to. (College/Institution, not individual)(Required.)
23.Payment address for above college/institution (specifically where scholarship payment should be sent)(Required.)
24.Student ID #(Required.)
25.Name of major/degree program(Required.)
26.Date by which you expect to complete your studies(Required.)
IMPORTANT - Please attach the following additional information to your application form:
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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28.Written recommendation from the facility Administrator and the Director of Nursing/Direct Supervisor.
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29.A copy of the letter of acceptance from the accredited school where the applicant has been accepted or is enrolled (For nursing, the letter must indicate that the applicant is enrolled in or has been accepted into a LPN or RN program).
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30. Any other documents that you feel would enhance your application.
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31.Additional Document 2
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32.Additional Document 3
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33.Additional Document 4
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PLEASE NOTE: If you have additional files you would like to submit beyond the ones attached to this application form, please email those files to Pam Clayton at pclayton@ghca.info
34.STATEMENT OF ACCURACY
I hereby verify that the information I am submitting is true to the best of my knowledge and I agree to submit proof of the same, should such information be requested. I further agree that any scholarship funds received by me from the Foundation will be used by me to further my education in Long Term Care.(Required.)