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 course accessible, and has obtained funding to support scholarships. The eligibility criteria and number of opportunities available for each scholarship vary - however, only applications from individuals that work, study, or live in New York will be considered.

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).

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.
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Email *
Full name *
Home Address (reminder: our scholarships are only open to individuals that work, study, or live in New York) *
Work/School Address (reminder: our scholarships are only open to individuals that work, study, or live in New York) *
Organization/Company *
Job Title *
If you are a licensed NY social worker, please enter your license #
If you are a CHES/MCHES, please enter your certification #
Please upload your resume/CV with your full name as the file name here: https://bit.ly/3xN97Md *
Required
How did you hear about this program? *
Why do you want to take this course?  *
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?
 *
Please describe your financial need for this scholarship. *
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?
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