NCHES – Continuing Education Scholarship Program Application
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General Information                                                                                Date:______________
 

Name______________________________________________________________
            (Last)                                                   (First)

 

Present Address______________________________________________________                                                         (Street)                                     (City)               (State) (Zip Code)

 

Phone:_______________________________________________________________ 
                           (Home)                                                (Work - optional)                   

 
Social Security Number:_________________________________________________

 
Current Employer or College/ Univ._________________________________________

 
NCHES Member Certification

This is to certify that the applicant is currently an active NCHES member in good standing.

_______________________________                                  ___________________
(Signed by a NCHES Board Member)                                        (Date)

 
Educational Information

List all Colleges / Universities attended (included present):

College / University                                 Date of Attendance                   Graduation Date

_______________________              ________________                _____________

_______________________              ________________                _____________

_______________________              ________________                _____________

 

College / University / Professional Certification Program or Continuing Education Programs you are planning to attend:

___________________________________________________________________

 

Full or Part Time?______________                      Have you been Accepted?___________

Major Field of Study __________________________   G.P.A.   ________________

Number of Completed Credits:________________

 
Employment Information (if applicable)
 
Current Employer __________________________Years With Employer___________

Employment History (previous 5 years): 

      Company Name and Address                         Years There               Position

_____________________________              ___________              ________________

_____________________________             

_____________________________              ____________            _________________

_____________________________

 
Supplemental Information

1.         Copy of current transcript (if applicable)                                _______________

2.                  Summary describing educational goals, career interests,
community / volunteer experience and financial need
(if applicable).                                                                           ________________

3.         Include a brief description of NCHES
            participation in the past 12 months.                                       ________________

4.        Two letters of recommendation (one from
            an employer or education advisor).                                        _________________

All of the above should be submitted in 3 copies to the NCHES Treasurer in a
sealed envelope addressed to the “Scholarship Selection Committee”, or mailed
to the address below.

 
Application Certification
The information contained in the application is accurate to the best of my knowledge.  I understand that scholarships are awarded at the discretion of the Scholarship Selection Committee and I give the committee permission to contact my school, references and employer for verification of this information.  I understand that I may be requested to return this award if I do not complete this course of study.

 

________________________________                                        __________________
(Applicants Signature)                                                                           (Date)

Mail To:            NCHES

                        Att: Scholarship Selection Committee
                        PO Box 59614
                        Washington DC, 20012

 
Received and Reviewed by Scholarship Selection Committee           

 

____________________________________              Date_____________________

___________________________________              Date_____________________

___________________________________              Date_____________________

 

Approved __________________________                    Disapproved_______________