Fall 2017 Scholarship Application Form Applicant's full name*Applicant's phone number*Applicant's mailing address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant's email address* Facility where applicant is employed*Facility PC #*Please enter a value between 0 and 999.HHS Director can provide this if you do not know it.HHS Director name*HHS Director email address* Team Member ID*This is a 5 digit number unique to each Team MemberWhich service line does the team member work for?*EVS (Housekeeping)CulinaryPatient Transport (Transport, Valet, Linen Utility Management)Facilities ManagementSenior LivingHow long has the applicant worked for HHS?*0-1 Year1-2 Years2-3 Years3-5 Years5-10 Years10+ YearsAre you a previous scholarship recipient?*YesNoPreviously applied but did not receiveWhat level of education have you completed?*Some High SchoolHighschool GraduateSome CollegeAssociates Degree (2 Year)Bachelors Degree or HigherTrade School CertificationWhat type of education will you pursue with this scholarship?*GEDTyping ClassEnglish ClassSpanish ClassTrade SchoolAssociates DegreeBachelors Degree or HigherHave you identified a specific school or class that the scholarship money will go toward?*YesNoIf you haven't, please take some time to do so before proceeding with your scholarship application.Name of school or institution*Please provide the name of the school or institution you plan to attend if you are awarded a scholarship.Please describe the vocational program or class(es) you are interested in taking.*What is the total dollar amount you are requesting for this school, vocational program, or class(es)? (Please be specific)*Please enter a value between 1 and 7500.What date do classes start?* When would you need to receive the scholarship funds in order to enroll?* How many hours a week will you work during your class?*01-1010-2020-3030-4040-5050-6060+Are you currently receiving financial aid?*YesNoDo you plan to develop a career with HHS?*YesNoIf yes, how will these classes help you achieve that goal?*Failure is a big part of success, can you tell us about a time when you failed and how it helped you grow as a person?*What are you passionate about outside of school?*Who is someone you look up to? It could be someone you know or a role model you have never met.*What makes you an ideal candidate for this opportunity?*Is there anything you feel we should know about you that was not included in the questions above?*How did you hear about the HHS Scholarship program?*PosterEMBColleagueWebsiteHHS ManagerOtherNameThis field is for validation purposes and should be left unchanged.