Staff HCA Scholarship – Harvest Forms

Staff HCA Scholarship Application

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

Position at Harvest

Number of years on staff

Spouse's Name (if applicable)

First

Last

Is your spouse employed?

Employer's name and position

Did you receive a scholarship from us last year?

Number of children that will be attending HCA next year:

List Children's Full Name/Birth Date/Grade in Fall

If you have children attending preschool, state number of days per week/what days of the week and times - AM, PM or Full Day

Name of school your children currently attend:

What year will these children begin attending HCA:

Notable Circumstances (talents, achievements, limitations):

Any further comments:

I understand that this application for scholarship does not entitle my family to any scholarship monies. I understand that in order to receive this scholarship I must adhere to the Children in the Workplace policy. I also understand that any scholarship granted to me will be taxed as a taxable fringe benefit.

Yes

Signature

Clear

Date

Time

If you are human, leave this field blank.

Staff HCA Scholarship Application

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