Scholarship

Annual Scholarship Request Form

The ACT I board has approved scholarships for 2020. If you, a staff member or an employee of your organization would like to apply, please fill out the complete form below.

To be considered for a scholarship, applications must be reviewed no later than:

The ACTI Scholarship Grants Review Committee will review the applications at our next board meeting. Awards will be presented at the general meeting. Recipients and their nominators (must be an ACT I member) will be notified prior to and we invite both the recipient and the nominator to attend the general meeting. All applicants must complete the following pages to be considered for an ACT I Scholarship. All applicants must provide proof of enrollment in an approved educational program prior to the Scholarship Grants Review Meeting.

Subject

Applicant/Nominator Information:

Applicant/Nominator Name (required)

Educational Program:Geriatrics (Incl. Care-giving & Psychiatry):Social Services:Nursing (Incl. CNS):

Related Program: (required)

ACT 1 Member Organization:

Business Name: (required)

Business Address: (required)

Business City/State/Zip: (required)

Nominated By:

Nominated By Name: (required)

Nominated By Phone: (required)

Section 1: Contact Information

Name (required)

Address: (required)

City/State/Zip: (required)

Daytime phone: (required)

Cell phone: (required)

Email (required)

Section 2: Educational History (Please check one)

Freshman:Sophomore:Junior:Senior:Master’s:Doctorate:PhD:

College/University: (required)

Major: (required)

Minor: (required)

Degree: (required)

GPA: (required)

Section 3: Honors, Awards and Extra Curricular Activities:

Please list honors, awards and extra curricular activities: (required)

Section 4: Essay:

Explain why you think you should be awarded this scholarship.

Within one page (about 300 words) please answer the following questions:

1) What are your goals (both academic and career)?
2) What have you already accomplished (personally, academically, volunteer and/or community involvement?
3) Why are you pursuing an education/career in this industry? What is your motivation?
4) Why are you applying for an ACT I Scholarship (financial need, member encouragement, etc.?)

Essay: (required)

Section 5: Proof of Enrollment and Letters of Recommendation:

Please attach below a headshot photo, two (2) letters of recommendation from people directly familiar with your work or education in the eldercare, medical, social services or related fields. Please also provide/attach proof of enrollment in an ACT I Scholarship-approved educational program. File formats accepted are Jpeg, PDF, PNG or GIF.

Letter 1: (required)

Letter 2: (required)

Proof of enrollment in an ACT I Scholarship-approved educational program: (required)

Headshot: (required)

Please check below if your agree under the penalty of perjury that this application and its attachments are true and accurate. I understand that if I withdraw my enrollment from an approved program of study that I am required to return the ACT I Scholarship award (if awarded) in full. I understand that this application and its attachments become the property of ACT I (Aging Community Team) upon submission.

I AGREEI DO NOT AGREE