MHAP Scholarship Form

MHAP ™ Discount Request Form

For partial / full tuition waiver for the Mental Health Administrative Professional program.
Completing this form does NOT mean you are enrolled in the Mental Health Administrative Professional (MHAP™) program. Since space is limited to 100 students per cohort, preference will be given to students who are able to pay partial tuition. You will be notified by email of your award or waitlist status within seven days of your application being submitted and will be instructed on how to complete enrollment at that time.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Optional Informations

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards.
Please indicate your previous educational experience:

I did not graduate high school.I earned a high school diploma, GED or similar completion certificate.I have completed some college courses.I have received an AA or similar two-year degree.I have received a Bachelors or similar four-year degree.I have completed some graduate school.I have a Masters degree or higher.
Are you a first generation college student?

Yes, I am the first among my parents or grandparents to attend any type of post-high school education or training..No, either my parents or grandparents have attended college.
Please check your veteran status.

VeteranChild of a VeteranGrandchild of a VeteranSpouse of a VeteranNone of the Above
Please check all of the following boxes that apply:

I or my spouse / partner is or was a law enforcement officer or first responder.I am a single parent with one or more minor children.I receive SNAP or other food or housing assistance.I am a convicted felon.I am living with a disability, as defined under the Americans with Disabilities Act.
What is your career objective and/or reason for interest in the MHAP course?

0/300
Have you already paid for your MHAP course registration?

YesNo
What is the maximum amount you can pay each month, over nine months towards earning your MHAP certificate?
Please describe your previous professional experience working in the mental health field:
VII. Essay
Please tell us in 200-300 words, why you're interested in earning the MHAP certificate and the positive impact it will make on you, your family, your community and your career. Please do NOT worry excessively about your punctuation, spelling, etc. We're interested in your story and heart, not your ability to write a paper.
Essay

0/500
VIII. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature

Clear
SemiPrivatePractice.com is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

MHAP ™ Discount Request Form

I. Personal Data

VII. Essay

VIII. Applicant's E-Signature