Scholarship Career Training Program
This scholarship is based on income and offers subsidized tuition. We extend our heartfelt gratitude to our Sponsors for their generous support in providing scholarships to our deserving candidates. Your commitment to education and empowerment is making a significant impact on the lives of these students, enabling them to pursue their dreams and achieve their goals. Thank You for Your Generous Support!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Age
*
Please Select
18-24
25-36
37-45
46-55
55+
Highest Level of Education
*
Please Select
Without a Diploma/GED
High School Diploma-GED
Some College
Associate Degree
Bachelor Degree
Master Degree
Doctorate Degree
Which training course would you like to complete (select all that applies):
*
Clinical Research
Phlebotomy
EKG
Projected Start Date
*
-
Month
-
Day
Year
Date
Select Training Locations
*
Please Select
Online Only
Online and Upland, PA ( Chester Crozer Medical Center)
Online and Upper Darby Twnp., PA.
Online and Dunwoody, GA.
Online and Tampa/St. Pete., FL Area
Employment Status
*
I'm currently working
I'm not working
I've been laid off
I lost my job
Current Occupation:
*
Unemployment Compensation:
*
I'm currently receiving UC
I've exhausted my UC
I'm eligible but not receiving UC
I'm not receiving nor eligible for UC
My Wages (select all that apply)
*
I'm working less than 28 hrs per week
My wages are less than my previous job
None apply
Are you head of household?
*
Yes
No
Household Size
*
Please Select
1
2
3
4
5
6
7
8
9
10
Monthly Household Income ($)
*
Please Select
0 - 2,510
2,511 - 3,408
3,509 - 4,304
4,305 - 5,200
5,201 - 6,098
6,099 - 6,994
6,995 - 7,890
7,891 - 8,788
8,789 - 9,686
9,687 - 10,584
Public Assistance
Yes
No
Disability
*
Yes
No
Have you participated in any volunteer work over the last year?
*
Yes
No
If yes, please explain:
Would you like to participate in our Community-Based Volunteer/Leadership Program?
*
Yes
No
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This scholarship is based on income and offers subsidized tuition. To qualify for scholarship funded training, please submit your personal identifying information through this form. By doing so, you acknowledge and agree that this information will be used exclusively to assess your eligibility for our training program and will be managed in accordance with our Privacy Policy. While providing your information is not mandatory, it may be necessary to access specific services or details about the training. Rest assured, we will never sell, trade, or rent your personal information to any third parties.
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