Student Contact and Qualifying Information

* 1. Please provide current contact information

* 2. Country

In order to be eligible for the A Place for Mom Senior Care Scholarship the student must be planning on pursuing a career that involves working with senior citizens and must be attending classes at an accredited college or university at the time of the spring deadline.

* 3. Will your future career involve working with senior citizens?

* 4. On April 15, 2017 I will be:

* 5. What is the name of the college or university you will be attending on April 15,2017

* 6. University location (City)

* 7. University location (State/Province)

* 8. What type of degree are you currently pursuing?

* 9. What is your major?

* 10. What is your anticipated graduation date?

* 11. Please tell us in a few sentences why you are seeking a career in your field and why you would be a good candidate for this scholarship award.

Applicants must also write a 400 to 700 word essay on the selected topic as well as email us a hand signed copy of the Scholarship Award Agreement. Please email your hand signed agreement and essay to The easiest way to send the agreement is to print it, fill it out, sign it and then take a clear photo of it and email that file to us. The agreement must be hand signed to be valid. Agreements which are digitally signed, typed, printed or blank will not be accepted.

* 12. I have emailed my essay and hand signed Scholarship Award Agreement form to