Continuing Healthcare Education Scholarship Application Form

Please use the online form below to submit your Continuing Healthcare Education scholarship application.

Name*
First Last
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Length of residence/work in Chelan area:*
Course/Program you plan to take (no acronyms):*
Administer by:*
Attach copy of registration form:*
Max. file size: 50 MB.
Date & Location of course/program*
Number of C.E. Credits:*
Deadline for registration:*
MM slash DD slash YYYY
Registration for Program/Course Expense:*
Meals included?*
- Yes
- No
Cost of Books:*
Have you received a Bragg Scholarship previously?*
- Yes
- No
If yes, what year?*
Educational Background*
School Location Dates Field of Study GPA
Employment History*
Employer Address Dates Responsibilities
Current Position Title*
Is course required by employer?*
- Yes
- No
Is course required for certification in your current position?*
- Yes
- No
Is this an online course/program?*
- Yes
- No
Why are you applying for these funds?*
Explain your career goals and how this course/program will benefit health care:*
Are you available for a personal interview?*
- Yes
- No
I certify that to the best of my knowledge the information contained in this application is true and correct. I understand that this application will not be considered for review unless it is signed and dated. I also understand that no materials will be returned.*
- Yes (digital signature)
Name
This field is for validation purposes and should be left unchanged.

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School	Location	Dates	Field of Study	GPA

Employer	Address	Dates	Responsibilities