Scholarship Application | Caregiver Incentive Project

Apply for a CIP scholarship or grant

Fill out the form below to apply for a CIP scholarship or grant. We will reach out to confirm your submission and will announce awardees by email.

If you prefer, download this application as a PDF and email the completed version to .

Full Name

Phone

Email Address

Date Of Birth

Year In School

Major

Minor (optional)

Anticipated Degree or Certificate

Anticipate Semester of Graduation or Certificate Completion

Fall Spring Summer

Anticipated Year of Graduation or Certificate of Completion

2024 2025 2026 2027 or later

Average Hours Per Week as a Caregiver

Describe your current caregiving employment. (Include information on hours, level of care/support required, wage earned, previous experience, previous training, etc.)

In 100 words or less, discuss your understanding of the national in-home caregiver shortage. How can you be a part of reducing the shortage? What experiences or factors have shaped your interest in addressing the caregiver shortage?

In 100 words or less: Describe examples and experiences that demonstrate you can work effectively with elderly, adult disabled or medically fragile individuals. Describe any difficulties you have encountered or that you think you might encounter when working with any of the groups mentioned above.

In 100 words or less: What motivates you to begin/continue working as an in-home caregiver currently?

In 100 words or less: How do you balance your work, education, and personal life? What supports are in place for you?

Have you attended a CIP Caregiver Academy?

Yes No

If awarded a scholarship, are you willing to participate in publicity events, surveys, training and/or other CIP activities?

Yes No

I understand that I must find my own employment and work as an in-home caregiver to receive payment of this scholarship if awarded to me.

Yes No

Are you willing to have your Name, Image and/or Likeness used in CIP Publicity and Marketing materials?

Yes No

Is there anything else you would like us to know about you? If so, please put it here in 100 words or less. (optional)

Please type your full name here. (This serves as your "digital signature" and confirms that the above information is true and accurate.)

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