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.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Please enter the following for your personal home address information.

Question Title

* 3. Home Address 1

Question Title

* 4. Home Address 2

Question Title

* 5. City

Question Title

* 6. State

Question Title

* 7. Zip

Question Title

* 8. Phone

Question Title

* 9. Personal Email

Question Title

* 10. Name of GHCA member SNF/ALF/SOURCE agency where you work

Please enter the following for your work address information.

Question Title

* 11. Work Address Line 1

Question Title

* 12. Work Address Line 2

Question Title

* 13. City

Question Title

* 14. State

Question Title

* 15. Zip

Question Title

* 16. Work Phone

Question Title

* 17. Administrator First Name

Question Title

* 18. Administrator Last Name

Question Title

* 19. Administrator Email

Question Title

* 20. Dates of Employment

Question Title

* 21. College/Institution where you have been accepted

Question Title

* 22. If awarded scholarship, entity check should be made payable to. (College/Institution, not individual)

Question Title

* 23. Payment address for above college/institution (specifically where scholarship payment should be sent)

Question Title

* 24. Student ID #

Question Title

* 25. Name of major/degree program

Question Title

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

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

Question Title

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

Question Title

* 28. Written recommendation from the facility Administrator and the Director of Nursing/Direct Supervisor.

Question Title

* 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).

Question Title

* 30.  Any other documents that you feel would enhance your application.

Question Title

* 31. Additional Document 2

Question Title

* 32. Additional Document 3

Question Title

* 33. Additional Document 4

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

Question Title

* 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.

T