Nurse AideCertificationScholarship
Battle Creek Community Foundation
Purpose: To provide scholarships for individuals who have completed the Kellogg Community College Certified Nurse Aide Training Program in need of financial assistance for the Prometric State Exam for CENA.
Eligibility: Any person who has completed the Kellogg Community College Nurse Aide Training Program and needs financial assistance to take the State Exam.
Criteria for scholarship assistance: This scholarship is designed to provide assistance for Kellogg Community College Nurse Aide Training Program participants who exhibit financial need completing the State Exam for CENA.
Criteria as follows:
- Must exhibit financial need for assistance.
- Must show competition certificate of the Nurse Aide Training Program at Kellogg Community College.
- Completion Certificate must be dated within 90 days of this scholarship application.
Selection Process: A committee will determine the scholarship recipient based on criteria.
Individual Applying:
Name: ______Sex:___M___F Age:______
Email: ______Phone (home)______Phone (work)______
Address: ______City______Zip:______
Scholarship funding will be used for:
State Certification Testing for Certified Nursing Assistant
Proposed Expense:
$100 for CENA Testing Administration Fee
Total Amount Requested:
$ 100 payable to Kellogg Community College C/O ______(Student Name)
Demonstration of need (Please describe why these funds are needed, and how much, if any, will be provided by other sources):
Organization to whom this scholarship will be payable:
Kellogg Community College
Certification: I certify that this application is complete and accurate.
______
NameSignatureDate
This scholarship is made possible through the Battle Creek Community Foundation.
Please allow a minimum of 15 business days for consideration.
Financial Form Version 1
2 October 2012
Nurse AideCertification Scholarship
Battle Creek Community Foundation
Individual Applying:
Name: ______
Required Income Documentation
The following documents must be attached to all applications without exception. Originals will not be accepted. Copies must be provided. Documents will not be returned. Please mark out the Social Security number prior to submitting documentation.
ALL APPLICANTS MUST PROVIDE:
- Proof of completion certificateless than 90 days old from the Kellogg Community College Nurse Aide Training Program.
- Two (2) consecutive pay stubs for EACH parent, or unemployment check/verification showing gross and net income. If pay stubs are not available, provide letter of employment specifying gross salary signed and dated by employer on company letterhead.
- Documentation of following benefits (if applicable): Social Security, unemployment, disability, Green/Gold checks, retirement, pension, public assistance, Section 8, TANF (Temporary Assistance to Needy Families)
- Documentation of dependents not listed on tax return: Medicaid cards, custody agreement, school registration, letter from Social Service for foster children. (if applicable)
SPECIAL CIRCUMSTANCES
List and document any special circumstances that contribute to your request for financial assistance. Please use an additional sheet, if necessary. Examples of special circumstances include: major medical expenses not covered by insurance, separation, divorce, disability, job loss, change in income, etc.
______
NameSignatureDate
This grant is made possible through the Battle Creek Community Foundation.
Please allow a minimum of 15 business days for consideration.
Financial Form Version 1
2 October 2012