LWHRA Scholarship Form

LWHRA Scholarship Form

Applicant Information

First Name*

Last Name*

Email Address*

Address 1

Address 2

City

State

Zip

Country

Are You Currently Employed?*

Yes

No

Employer*

Are you an LWHRA Member?*

Yes

No

Have you Volunteered for LWHRA?*

Yes

No

Date When you Volunteered?

Received an LWHRA Scholarship the Last 12 Mths?*

Yes

No

Unique Factors We Should Consider When We Review

Certification

Please indicate the program and costs that you are requesting that the scholarship will cover

Check All Programs that Apply*

Certification Study Group

Cost of Certification Study Materials

HRCI Exam Fee

SHRM Exam Fee

HRCI and/or SHRM Accredited Continuing Education

Cost of HRCI Cert Program*

Institution*

HRCI Certification Level*

PHR

SPHR

GPHR

Cost of SHRM Cert Program*

SHRM-CP

SHRM-SCP

HRCI and/or SHRM Accredited Continuing Education

Name of Class, Seminar or Conference*

Date of Event*

Cost*

Location*

How Will This Event Enhance Your HR Career?*

Financial Request Information

Amount Requesting*

Are you eligible for funding outside of LWHRA?*

Yes

No

How much are you eligible to receive?

Seeking reimbursement for an outstanding expense?*

Yes

No

Date payment is due?

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