CHCA District 1199 Scholarship Application 2026 Award Cycle

CHCA District 1199 Scholarship Application 2026 Award Cycle

Please complete all required sections and review the policies before submitting your application.
Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Membership Status
Sponsoring Member Information
Complete this section only if you are a dependent of a CHCA District 1199 member.
Member's Full Name

First NameMiddle NameLast Name
Member's Employer
Member's Job Title
Member's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Member's Email Address
example@example.com
Relationship to Applicant
Educational Program
Name of Institution
Program / Degree Name
Field of Study
Program Type

Other
If Other, please specify
Enrollment Status
Modality
Expected Start Date

MonthDayYear
Date
Expected Graduation Date

MonthDayYear
Date
Proof of Enrollment or Acceptance Letter

Cancelof
Dependent Attestation
Attestation Note
Dependent Attestation
Member's Name for Attestation

First NameMiddle NameLast Name
Date of Attestation

MonthDayYear
Date
Applicant Certification
Certification Notice
Certification
Applicant's Full Name

First NameLast Name
Date

MonthDayYear
Date
Essay Submission
Essay Upload: Describe a moment when you saw the labor movement make a real difference- in your own life, in your family, at your workplace, or in your community, or in society at large. Explain what that moment taught you about why workers organize, and how it shapes the career you're pursuing in health care.

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CHCA District 1199 Scholarship Application 2026 Award Cycle

Applicant Information

Sponsoring Member Information

Educational Program

Dependent Attestation

Applicant Certification

Essay Submission