GROW SCHOLARSHIP APPLICATION

GROW SCHOLARSHIP APPLICATION

The GROW Scholarship is geared exclusively towards PHCC contractor members and their employees. It provides funding assistance for continuing education in a non-traditional or non-degree structured format, such as pursuing a license, certification, or specialized program.
I. CONTRACTOR MEMBER INFORMATION (Must Be PHCC National Auxiliary Member for 2 years)
Who is attending program?*

Business OwnerEmployee
Contractor Member Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What are your expected outcomes from this program?*
II. PERSONAL INFORMATION (Individual Attending Program)
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Phone Number*
Email *
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
III. PROGRAM INFORMATION
Name of License/Certification/Program Being Pursued*
School Name*
Program Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Will It Be Attended?*

Live/ClassroomVirtual
Currently Enrolled?*

YesNo
If Yes, Date of Enrollment

MonthDayYear
Date
If No, Anticipated Date of Enrollment

MonthDayYear
Date
If Applicable, Date of Completion

MonthDayYear
Date
IV. FINANCIAL INFORMATION

Answer all questions in this section with specific dollar amounts.
Anticipated Tuition Cost*
Anticipated Books Cost*
Anticipated Travel Cost*
Other Anticipated Costs (Please Explain)
Total Anticipated Costs*
What, if any, is student's personal financial contribution to this program?
How much assistance are you seeking for this program?*
Indicate Any Other Source of Assistance You Will Use
V. EDUCATION HISTORY INFORMATION
Date Applicant Received High School Diploma or GED (leave blank if N/A)

MonthDayYear
Date
Indicate Any Post-High School/GED Education or Training Programs Completed (include SCHOOL NAME, DATES ATTENDED, and NAME OF DEGREE/CERTIFICATION/LICENSE)
VI. EMPLOYMENT INFORMATION
Current Position*
Current Manager's Name*

First NameLast Name
Manager's Position/Title*
Manager's Phone Number*
Please enter a valid phone number.
Email*
example@example.com
VII. CAREER INFORMATION
Career Path (include whether student is looking to focus on breadth or depth of an expertise and/or looking to advance in upward positions) *
VIII. ESSAY
Write a Brief Essay (no more than 300 words) Describing Applicant's Commitment to Their Goals and How This Scholarship Will Help Attain These Goals*
IX. OTHER
Use This Space for Anything Additional You Would Like to Add
X. Signature
By signing this form, you give us the right to use photograph(s) in the announcement of the winners. I hereby certify that the above is true and accurate.
Signature*

Clear
Date*

MonthDayYear
Date
Upload proof of enrollment here

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Upload program receipt(s)

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Upload career development plan

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GROW SCHOLARSHIP APPLICATION

I. CONTRACTOR MEMBER INFORMATION (Must Be PHCC National Auxiliary Member for 2 years)

II. PERSONAL INFORMATION (Individual Attending Program)

III. PROGRAM INFORMATION

IV. FINANCIAL INFORMATION

V. EDUCATION HISTORY INFORMATION

VI. EMPLOYMENT INFORMATION

VII. CAREER INFORMATION

VIII. ESSAY

IX. OTHER

X. Signature