2015 Certified Nursing Assistant Tuition and Exam Scholarship

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1 2015 Certified Nursing Assistant Tuition and Exam Scholarship What is AOD? The Alliance for Opportunity and Development (AOD) is a Christian, non-profit organization based in Huntsville, Alabama that provides education and training opportunities to low-income families. Learn more at We hope you pursue a relationship with Jesus Christ alongside your education and career pursuits. Jesus said in Matthew 4:4, "It is written, Man shall not live on bread alone, but on every word that proceeds out of the mouth of God." Visit Scholarship Description: This $845 scholarship is for the Certified Nursing Assistant (CNA) program at J.F Drake State Community and Technical College for the class offered the class offered November 30 December 11, It covers the following expenses: Tuition ($745) and License Exam ($100). AOD will deposit funds for tuition in a student account at J.F. Drake State business office. AOD will make payment for license exam directly to the exam provider. Student Responsibilities: Review program details at: Complete all required registration and enrollment steps required by J.F. Drake State Pay for all other course expenses such as fees for the tuberculosis skin test and hepatitis B shots required by the program Purchase uniform items required by the program Eligibility: Financial need (priority is given to applicants whose income is near or below federal poverty guidelines for size of family, as evidenced by most recent tax return) 18 years of age or older U.S. citizen High School graduate or GED Possess current driver license (or state Identification card if disabilities prevent driving) Bank account in name of scholarship recipient Experience working in a medical facility and/or providing in-home care to a family member Intent to use this training to immediately seek employment as a Certified Nursing Assistant Selection Process: AOD will award one scholarship on a competitive basis. Selection criteria are financial need and level of confidence that the applicant will be a successful Certified Nursing Assistant (based on application, interview, and criminal background check) The selection team will review applications and select one or more applicants for interviews. The finalist will undergo a criminal background check prior to scholarship award. If selected for an interview, you must bring: o Copy of current Driver License o Proof of U.S. citizenship (e.g. Social Security card or birth certificate) o Social Security card (number will be used to initiate criminal background check 1

2 What Else Should I Know about Learn and Earn? AOD requires a copy of the course completion certificate AOD will assist with resume preparation, interview coaching, and job placement after course completion DATES AND DEADLINES Submit Application to AOD November 3, 2015 Interviews November 14-16, 2015 Selection Completed November 19, 2015 Applicants Notified November 20, 2015 SUBMISSION REQUIREMENTS Type or print clearly Complete all sections Include with this application: o Most recent tax return o Copy of pay stub if you are currently working o Copy of high school diploma or GED o Include transcript for any education or training obtained after high school o Copy of submitted FAFSA o Resumé o Optional: Letters of recommendation o Mail applications to (must be postmarked not later than November 3, 2015): AOD 6983 Wall Triana Hwy Suite S Madison, AL

3 1. Personal Information Name Date: Address Apt # City State Zip Code Home Phone Cell Phone 2. Eligibility Age Are you a U.S. citizen? (circle one) Yes No Did you graduate High School or earn a GED? Yes (year) No Do you have a current driver s license? (circle one) Yes No Describe your experience working in a medical facility and/or providing in-home care to a family member: Do you intend to immediately pursue employment as a CNA after completing this training? (circle one) Yes No 3. Why do you want to become a Certified Nursing Assistant? 4. What are your career goals? 2 years: 5 years: 3

4 5. Do you have college credit, degrees, or certifications from other schools? (circle one) Yes No If yes, list degrees or certificates and total number of credits Attach transcripts if you have taken classes at J.F. Drake State or any other school. 6. Work Experience Are you currently employed? (circle one) Yes No If yes, please indicate: Employer(s) Position Average hour per week What arrangements do you have with your employer(s) to continue working and attend classes? List work history below for last five years (attach a separate sheet of paper if necessary): From (mm/dd/yy) To (mm/dd/yy) Employer Position Avg hours per week 7. Family Status (circle one): Married Divorced Single Please list children or others you support First name / Last Name Age Relationship If applicable, describe childcare arrangements while you will be in school 4

5 8. Financial Income Sources Job Income (including spouse or partner) Child Support Food Stamps/EBT Housing Assistance Other List major expenses that you pay Expenses Rent or Mortgage (circle one) your share Car payment Child Support Cable/Satellite TV/Internet Cell Phone Other (specify): Total Total Amount - monthly Amount Describe how you will you be paying your bills while attending class: Do you have a savings and/or checking account? (circle one) Yes No If yes, list name of bank or credit union: 9. Transportation: How will you get to classes? Check one My own car Walk or bicycle Bus Unknown at this time Friend/relative 10. Criminal Record: Describe any arrests and/or convictions, include dates: 5

6 11. References: List at least two references, such as a pastor or supervisor, that can attest to your character and potential to succeed in your chosen education program. Name Relationship Known for How Long? Phone Number 12. Describe any community service activities you participate in or have participated in during the last 12 months. 13. Expectations of Scholarship Recipients If awarded an AOD scholarship, I understand or agree to (please initial next to each item) a. I understand AOD funding comes from private and business donations and not the Government. Scholarship funds for students who drop out or do not pass this program could have been used for other students. Therefore, I will commit to doing all I can to pass the program and find employment. b. Inform AOD of any changes affecting completion of your program c. Maintain contact with AOD (return phone calls or messages) d. Attempt to support AOD with participation in occasional fundraisers (e.g. car washes or information meetings) e. Attempt to participate in AOD events for scholarship recipients such as graduation celebration dinners or other similar events I attest that the information I have provided in this application is complete and accurate to the best of my knowledge. Signature Date 6