The Healthcare Training Academy requires a fully completed application to award scholarship funds.

each fund has its own criteria. upon submission of your application it will be reviewed by the appropriate committee. upon approval the scholarship award will be applied to your account.

as classes fill up very fast we recommend sign-up for your desired course while awaiting scholarship fund decision. any funds awarded will be applied to your account and, if appropriate, any credits created by the fund award will be refunded to you.

When submitting your application CLICK THE SUBMIT BUTTON ONCE (DO NOT DOUBLE-CLICK).

Please complete your application below. Please complete every field where applicable.


Applicant Name

Address


Phone

Primary & Alternate Email

Enter 3 peer references.   ENTER THE NAMES OF FELLOW CLASSMATES WHO WILL GIVE A REFERENCE FOR YOUR.

The references you enter MUST be fellow students/classmates who will verify how you are to work with during your nursing program.

Please DO NOT included non-nursing students. Your scholarship applications will be invalid if references are not properly entered or if the references you provide are not classmates.

An email will be sent to each of your peer references below to provide a 2-3 question survey to support your scholarship application.

Reference First name Last Name Email Occupation
Reference 1
Reference 2
Reference 3

When entering email addresses use a personal email (do not use school or a work email address ).


Enter the Nursing School you attdend(ed). In some cases we will need to email your dean for
verification. If you do not know your deans email address please look it up on your schools website or directory. The Dean of Student Affairs is an acceptable contact person to enter.

Nursing Program Info

Dean's Information
First Name: Last Name: Dean's Email: Title:


Student Nurse Association Information
This section MUST be completed by ALL applicants. Student Nurse Association (SNA)
SNA President First Name:
SNA President Last Name:
SNA President Email:

Click Here if you an SNA member:


If you have already taken certifications please enter the date each certification was issued.

Nursing License Information
Complete as much information as possible. This information will be verified with the National NurseSys database.



BLS (Basic Life Support)
ACLS (Advanced Cardiovascular Life Support)

PALS (Pediatric Advanced Life Support)
IV Therapy Certification

If none - enter "none"

In one short paragraph please tell us why you should be given a scholarship award
from the fund you have selected.



Click the submit button once (DO NOT DOUBLE-CLICK)
Duplicate entries will be rejecrted.

Step  of  steps.