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AP Scholarship Information

AP Scholarship Application



Dorothy Doughty Education Scholarships

2021 Advanced Practice Scholarship Application


Application form:

* denotes required fields









     



  




               

 



   
(300 words max)


*Financial Impact - Expenses:

 

 

 

 

*Are you eligible to receive tuition assistance / reimbursement from your employer?

  

300 words or less


*Have you received tuition assistance / reimbursement from your employer?

  

  

*Have you been awarded any other funds for your Advanced Practice Educational Program?:

  
  


     





              


*Employment History (begin with most recent)

Employer1:

Name: Location:
From: To:
Describe Position / duties performed

Employer2:

Name: Location:
From: To:
Describe Position / duties performed

Employer3:

Name: Location:
From: To:
Describe Position / duties performed

*Education Background (begin with most recent)

Education1:

Institution Name: Location:
Graduated: Degree Earned:

Education2:

Institution Name: Location:
Graduated: Degree Earned:

Education3:

Institution Name: Location:
Graduated: Degree Earned:

(300 words or less)


(300 words or less)


(300 words or less)


(300 words or less)



Scholarship recipients will be solely responsible for all federal, state and/or local taxes associated with the scholarship. In the event, a recipient receives an amount of $600 or more, they will be required to sign tax documents (W-9 form) BEFORE receiving scholarship payment.




  

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