Application - Park Springs Foundation

Application For Park Springs Foundation Scholarship

This form must be submitted before EVERY SEMESTER

"*" indicates required fields

Employee Information

Name*

First Last

Nickname:

Email:*

Cell Phone:*

Home Address:*

Home Address Line 2:

City:*

State:*

Zip Code:*

What month and year did you begin employment at Park Springs?*

Year*

Employment Status:*

Part-time

Full-time

In which area do you work?*

Administration

Clinic

Cobblestone

Environmental Services/Housekeeping

Food and Beverage

Home Care

Pebblebrook

Pebblebrook Memory Care

Plant Operations/Maintenance

Sales and Marketing

This field is hidden when viewing the form

In which department?

Supervisor*

Is this scholarship for you or for a relative?*

For me

For a relative

Relative’s Information

For your relative to be eligible for a Park Springs Foundation Scholarship, he or she must be your legal dependent and be claimed as such on your Federal Income Tax return.

Relative First Name:*

Relative Last Name:*

Relationship:*

Dependent children/grandchildren are eligible until the end of the semester in which they turn age 26.

I claim my child/grandchild as a dependent on my tax return:*

Yes

Student's date of birth:*

Email:*

Cell Phone:*

Home Address:*

Home Address Line 2:

City:*

State:*

Zip Code:*

School Information

Which School Will You Be Attending:*

What field of study?*

Have you already applied?*

Have you been accepted?*

For which semester are you currently applying?*

Fall 2026

Spring 2026

Summer 2026

Is the applicant a continuing or a new Park Springs Foundation Scholarship student?*

Continuing Applicant

New Applicant

We strongly recommend that the student complete the FAFSA form that serves as the application for a Pell grant and is available from the college’s Financial Aid office. This is free money from the Federal government. Talk with the Financial Aid office about what other support may be available. The Park Springs Foundation wants you to complete your education with as little debt as possible.

EMPLOYEE AGREEMENT

We are pleased to know of your interest in the Park Springs Foundation Scholarship Program. Here are some things you must understand and agree to before proceeding with an application. Please read carefully and sign below. The Park Springs Foundation is an organization of Park Springs members. It is entirely separate and distinct from Park Springs, your employer. Scholarships are sent to the school of your choice for each academic semester: Fall, Spring, and Summer. The employee applying for a scholarship for himself, herself, spouse, or child must have completed six months of service at Park Springs by August and must continue to be employed either full-time or part-time by Park Springs to continue receiving a scholarship. To be eligible, a child must be financially dependent on the employee applying for the scholarship. In making its decisions, the Scholarship Committee does not take into consideration the financial need of the applicant. Employees are eligible regardless of total income. To be eligible for college, the applicant must have finished high school or have completed the GED. Without this, you can still apply for scholarship help for the academic year, then complete the test for the GED, and subsequently apply for college admission. We also pay for GED preparation courses. Scholarships may be used to attend accredited professional programs, technical colleges, community colleges, and degree-granting colleges and universities. Public or private, in-state or out-of-state institutions are eligible so long as they are not-for-profit. Before a scholarship will be paid, you, your spouse, or your child (whoever will be attending college) must submit to the committee the class schedule, tuition and fee statement from the college, and their statement of other grants/scholarships being received (e.g., Pell grant, Hope or Zell Miller scholarship). If eligible, the student is encouraged to apply for a Pell grant. Scholarships are paid directly to the institution, not to the student. If for some reason you have to withdraw from your academic program and a refund is due, the refund must be returned to the Foundation. However, if your withdrawal was due to some legitimate extenuating circumstance, scholarship help may be available to you again when you are ready to resume your studies. THIS STATEMENT MUST BE SIGNED BY EMPLOYEE.

Digital Signature of Parks Springs Employee*

Date*

MM slash DD slash YYYY

PLEASE RETURN THIS APPLICATION AS SOON AS YOU ARE ADMITTED TO THE COLLEGE OF YOUR CHOICE.

Tuition Payment Form

The Application Form for this semester needs to be submitted before the Tuition Payment Form can be processed.

Your tuition request should be submitted at least 2 weeks before tuition and fees are due when possible.

For which semester is this request?(Required)

Student Name(Required)

Student's Email Address(Required)

Student School ID Number(Required)

School Name(Required)

School Address (where PAYMENT is to be sent).(Required)

Date Due

MM slash DD slash YYYY

School Phone Number

List all anticipated financial aid such as Pell Grant, other scholarships, or enter "None"(Required)

Upload Invoice(s)/Bill

A final invoice/bill showing your tuition owed for the upcoming semester, and all financial aid you are receiving (e.g. Pell Grant, Hope Scholarship, etc.)

Drop files here or

Accepted file types: pdf, png, jpg, docx, Max. file size: 50 MB.

Any Additional Notes

Book and Supply Reimbursement Form

The Application Form for this semester needs to be submitted before the Book and Supply Reimbursement Form can be processed.

"*" indicates required fields

For which semester is this request?

Student Name

Student's Email Address

Total Book/Supply Amount

Receipts must be attached for payment!

Payment Options:*

Zelle

Venmo

Mailed Check; fill in mailing address:

Venmo Username*

Students Phone Number*

Zelle ID*

Mailing Address

Upload Receipt(s)