Scholarship Application

* Scholarship(s) applying for: Please select one

Undergraduate/Graduate
PSHRA-SCP/PSHRA-CP Certification Exam
Municipal/County Administration
PSHRA NC Annual Conference

How will this scholarship benefit you in the profession of Human Resources Management, and what are your career goals?

General Information

* Name:

* Address:

City:

* ZIP:

Employment Information

* Employer:

* Department

* Position:

* Business Phone:

* Business Address:

* Length of Time in HR:

* Length of Time in Current Position:

* PSHRA NC Membership Join Date:

* Brief description of current job:

* Educational Background select highest level completed

* PSHRA NC Activities:

County/Municipal Administration:

(Complete the following section if you are applying for a scholarship for this program.)

List any community activities, positions held in organizations and any other activities or offices held that might be indicative of your leadership ability:

Estimated Costs: Include amounts for registration, travel, and lodging expenses.

Undergraduate/Graduate/PSHRA-SCP/PSHRA-CP/Annual Conference:

Complete the following section if you are applying for a scholarship to assist in paying for the completion of approved courses.

I hereby submit the following course(s) for approval under the procedures of the PSHRA NC Scholarship Program offered by the following institution: Please provide copies of course grades and costs of courses and books.

Course Title:

Date Begins:

Date Ends:

Registration Cost:

Tuition:

Cost Course Materials:

I am working toward: Certification, Degree, or Credit Only

I certify that the above information truly represents my background and experience. I
understand that if my application is approved, the PSHRA NC Chapter will award a maximum of
$1,000 per academic course not to exceed $1,000 per year. I further understand that upon my
completion of the course(s) I will provide certification by the Institute that I have met the
standards of the program(s), and the admission of all required documentation for approved
expenses.

* Signature Enter Name and Date

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