EmailMe Form - Foundation Scholarship Application Form

Eligibility Requirements

• Currently employed (full-time or part-time), work for a facility, housing, home care, or community member of Care Providers of Minnesota
• Must have at least one year of long-term care work experience
• Enrolled (or enrolled no later than fall 2024) in an accredited course of study leading to a career path serving seniors and/or persons with disabilities and/or a program of study leading to Assisted Living Licensure; and that course of study will lead to a new /continuation of a career in post-acute/long-term care/long-term services and supports and/or a professional certification program
• Scholarships cannot be used for past education reimbursement or continuing
education to maintain one’s license
Scholarship recipients must remain employed with qualifying Care Providers of Minnesota employer both at the time of selection and at the time of their award presentation to receive their scholarship. Scholarship recipients must show proof of enrollment before receiving funding.
* Photos of recipients may be used in Care Providers of Minnesota Foundation promotions
It is the responsibility of the applicant to ensure the submission packet is complete and that all recommendations are received by the July 12 , 2024, deadline. Applicants are advised to confirm both references have been completed.

I have read and understand all the eligibility requirements. *

YES

NO

Name *

First Last

Email *

Home Street Address *

City *

State *

Zip Code *

Personal Phone *

### - ### - ####

Employer's General Phone Number *

### - ### - ####

APPLICANT MUST HAVE AT LEAST ONE YEAR OF LONG-TERM CARE WORK EXPERIENCE* *

I have one or more years of long-term care work experience

I DO NOT HAVE one or more years long-term care work experience

*If less then one year with current employer, your supervisor must verify prior employment to ensure one year long-term care work experience.

Current Employer *

Current Employer Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Employment History *

	Position	Employer	Employment Dates
Current Employer

Previous Employment History

	Position	Employer	Employment Dates
Previous Employer #1
Previous Employer #2

Identify your intended program of study and it's connection to the long-term care profession- Please state clearly without using acronyms: *

Are you enrolled or accepted in an accredited educational institution? *

Yes

No

If yes, where?

Identify any special training or course work you have had in related fields:

Have you applied for a Care Providers of MN Foundation Scholarship or mini-grant before? *

Yes

No

If yes, when?

Have you received a Care Providers of MN Foundation Scholarship or mini-grant before? *

Yes

No

If yes, when?

Essay Portion

In your own words, write your responses to all of the following questions:

1. Why did you choose a career in care and service delivery for seniors and/or persons with disabilities? *

2. How would you use this education to further your career serving seniors and/or persons with disabilities? *

3. Provide at least one example of when you positively impacted someone through the care or services you provided. *

NOTE: Specific Example REQUIRED

4. How have you positively impacted your organization and increased its effectiveness (through teaching, mentoring, serving on committees, etc.)? *

Essay Portion

After you submit this form, personal and professional recommendations are also required for a completed application.