Michigan Achievement Skills Scholarship Interest
This form collects basic information from individuals interested in nursing skilled trades to help connect them with relevant opportunities and resources.
Student Name
*
First Name
Last Name
Student Email
*
example@example.com
Did you recently graduate from high school or a GED program in 2023, 2024, or 2025? Will you graduate in 2026?
*
Yes (you may be eligible for Michigan Achievement Skills Scholarship)
No (You are not eligible for Michigan Achievement Skills Scholarship)
Do You Receive Snap Benefits AND live OUTSIDE of Detroit? (You may be eligible for funding through Skilled U.S.)
*
Yes, I receive Snap Benefits and I do NOT live in Detroit.
No, I do not receive Snap Benefits.
What city do you live in? (Determines what funding you may be eligible for)
*
Student DOB
Student Phone Number
*
Please enter a valid phone number.
Student Age
*
Do You have A Copy Of Your High School Diploma or GED Certification?
*
Yes
No
Do you live in Wayne County?
*
Will you use your 2025/2026 Michigan Achievement Scholarship for college?
No
Yes
Have you ever been convicted of a felony?
No
Yes
Name of High School or GED Training Center
What year did you graduate High School or a GED program? If you will graduate in 2026 put your graduation date here
*
Do you have a valid government-issued ID?
*
Please Select
Yes
No
Waiting on it to come
Upload Valid ID
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Copy of Your High School Diploma or GED
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Which Program Are You Interested In? (Select all that apply)
*
CNA (3 Week Hybrid Classes-13 Days (4 online Days, 9 In-person Days)
Phlebotomy (4-Week Classes/ Hybrid Evenings (4pm- 9pm; Meets 3 days online; 1 day in-person)
Select a Hybrid Class Time:
*
CNA Day (0800am-2:30pm)
CNA Afternoon (11: 30am-5:30 pm)
Phlebotomy Evening (4pm-9pm)
Which CNA class are you interested in?
Jan 5- Jan 21, 2026
Feb 2- Feb 18, 2026
Mar 2- Mar 18, 2026
April 6- April 22, 2026
April 27-May 13, 2026
June 1-June 17, 2026
Confirm CNA Class Type:
*
Hybrid (4 online days; 9 in-person days.)
Which Phlebotomy Class are you interested in? (All classes are Evening and Hybrid)
Jan 5- Feb 19, 2029
Parent's Phone Number (For student's under 18)
example@example.com
Parent’s Email Address (for students under 18)
example@example.com
Who referred you?
Refer a friend.
Additional information:
Please add any additional information that may help us ensure that we understand your needs.
Signature: I understand Michigan Achievement Skills Scholarship covers TUITION ONLY. I must pay a $50 registration fee to be enrolled in class. I understand I must cover the cost of my supplies (Textbook, scrubs, TB test).
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