Scholarship Application: End of Life Care Community Advocate Training
INSTRUCTIONS:

Thank you for your interest in our course. End of Life Choices New York strives to make this training accessible, and has obtained funding to support scholarships. 

At this time, we are able to offer a limited number of full scholarships.  We will first consider your application for a full scholarship. If we are unable to offer you a full scholarship, we will consider your application for a partial scholarship (i.e., a discounted rate). Only applications from individuals that work or study in New York will be considered.

Please complete this form in its entirety. We will notify you via email once a decision has been reached.

If you have any questions or concerns regarding this form or the application process, please email education@eolcny.org. Thank you for taking the time to complete this form.
Sign in to Google to save your progress. Learn more
Email *
Full name *
Home Zip Code *
Work/School Address (reminder: our scholarships are only open to individuals that work or study in New York) *
Organization/Company *
Job Title *
Please take a moment to upload your resume/CV with your full name as the file name by clicking this link (it will open in a new tab) and then come back to this application to complete it: https://bit.ly/3xN97Md *
Required
How did you hear about this training? *
Why do you want to take this training?  *
How do you hope to use what you learn in this course to help NY communities when planning for or navigating the end of life?
 *
The full cost of the training is $845 early bird (until 8/31) and then $999 starting 9/1. Please indicate the amount you would be able to pay if we are only able to offer you a partial scholarship.  *
Some of our scholarship funds are to support specific communities or professionals. To determine your eligibility for these scholarships, please provide the following information.
What is your occupation? *
Which communities/populations do you serve in New York? Check all that apply. *
Required
Please describe your work with these communities. *
What is your race/ethnicity? Check all that apply. *
Required
Do you identify as a member of the LGBTQIA+ community? *
What is your gender? (choose what feels right for you, and check all that apply) *
Required
What is your age? *
Is there anything else you would like us to know?
By submitting this form you attest that you have completed this application honestly and that you have genuine financial need for a scholarship.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of End of Life Choices New York. Report Abuse
Google Forms