South Dakota Health Care Association (SDHCA) Scholarship Application
SDHCA will award a $1,000.00 scholarship for training in the health care field to a qualified person who wishes to further his/her education and practice in the long term health care profession. This scholarship will be awarded for the Fall 2018 Semester. Only complete application packets will be considered.

Reference forms need to be given to those you choose to have complete them and Reference must mail or email form back to SDHCA at address indicated on the form.

Please complete the entire application packet no later than June 30, 2018. Questions can be directed to sdhca@sdhca.org or call 1-800-952-3052.

To download a printable application packet: https://drive.google.com/file/d/1lo0cbd8oDzBgFhb4A5KXb8jA5TxnD9CM/view?usp=sharing

Name of Applicant *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Home Phone or Cell Phone # *
Your answer
Name of Center where you are employed *
Your answer
City *
Your answer
Position *
Your answer
Starting date of your employment at this Center *
MM
/
DD
/
YYYY
Are you still employed at this Center? *
Your answer
Name of your Supervisor *
Your answer
List College/Technical School which you are attending or have been accepted:
Your answer
City, State, Zip
Your answer
How many quarters or semesters have you completed? *
Your answer
How many credit hours per quarter or semester?
Your answer
Current GPA? *
Your answer
Major or Degree you are obtaining? *
Your answer
Have you had any other special training related to long term health care? If so, please explain.
Your answer
Please describe your interest in long term health care, including how you became interested in the profession and related experiences you have had:
Your answer
Please describe your future professional plans in the health care field and your commitment to the long term health care field:
Your answer
Reference Forms - please print, then distribute one of each of the following Reference Forms. The Reference will mail or email to the address indicated on each Form
Scholarship Agreement: As the recipient of the SDHCA Scholarship, you are agreeing to the following conditions of the scholarship program. *
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