Caregiver Application Form| Jean Griswold Foundation

We appreciate all that you do in caring for others, and we are thrilled to offer you this opportunity to follow your dreams in the care industry! In this section, you will enter your personal and professional information as your application for a Winter 2023 Jean Griswold Foundation scholarship. Please note that your application is not considered complete or eligible for scholarship until this form is submitted and a recommendation form is completed and submitted by a supervisor nominating you for this award by 11:59 pm ET on October 21, 2023. Supervisors may be from your home care agency, or a client you care for through private duty or a care pairing registry. You are encouraged to check in with the person recommending you to ensure they complete and submit their form. You will receive an email confirming successful submission.

First Name*
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Last Name*
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Email*
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Address (Street Address, City, State, ZIP)*
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Phone Number for text updates (Your provider’s standard data and text messaging rates apply. Opt out of text messaging anytime)*
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Highest Level of Education Achieved*
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Current Student status (check one). NOTE: Jean Griswold Foundation scholarships are paid directly to the federally accredited educational organization and must be used within 12 months of the award date.*
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License, Certification, Course Subjects, or degree you are pursuing*
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Household Income*
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Do you have any financial dependents? If so, please enter how many dependents you claim.*
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What do you anticipate your total educational fees to be for this current pursuit (how much does this degree or certification cost)?*
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When did you begin this coursework? (If you have not yet started, please use your acceptance date and start date)*
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When does this program end (when will your coursework be completed)?*
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Name of Federally Accredited School* (if selected. If school not yet selected, write “TBD”)
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School Phone Number* (if selected. If school not yet selected, write “TBD”)
Please enter your school phone number.
School Address* (if selected. If school not yet selected, write “TBD”)
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Student ID (if known. If school not yet selected, write “TBD”)*
Please enter your student ID.
Nearest Griswold Office (Griswold employment/referral history is not a requirement for scholarship application)*
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Name of Company
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How did you hear about the Jean Griswold Foundation Scholarship Program?*
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Name of Supervisor Recommending You*
Please enter supervisor's name
In 3-5 sentences, please describe what you would do with this scholarship.
Examples may include description of what certification or degree this scholarship will pay/help pay for.*
Please answer prompt.
In 3-5 sentences, please tell us what brought you to caregiving.
This may be professional or family caregiving role or interest.*
Please answer prompt.
In 3-5 sentences, please tell us why you are pursuing this educational advancement now.*
Please answer prompt.
In 3-5 sentences, please tell us why you deserve this scholarship.*
Please answer prompt.
I have read and understand the terms of service*
- I have read and understand the terms of service*
  Please verify that you have read and understood the terms of service.

*indicates required field.

Welcome Caregiver Scholarship Applicants!