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Location:
240 South Rock Blvd.
Suite 143
Reno, NV 89502
T.E.A.C.H. Nevada Scholarship Application
Apply Today
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2017-10-17T20:53:33+00:00
TEACH Scholarship Application
Apply for a TEACH Nevada Scholarship
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Address
Home Phone
*
Home Phone
Cell Phone
Cell Phone
Email
Date of Birth
Month
Day
Year
Date of Birth
Gender
Female
Male
Non-Binary
Semester you would like you scholarship to begin:
Spring
Summer
Fall
Winter
Which degree are you applying for?
ECE Credits to advance in The Nevada Registry Career Ladder
ECE Certificate / Credential
ECE Associate Degree
ECE Bachelor Degree
NDE License / Endorsement
College or university you plan to attend:
*
College or university you plan to attend:
How did you hear about the T.E.A.C.H. Early Childhood® Program?
Presentation
College
My Center Director
T.E.A.C.H. Recipient
Website
Director’s Name
Director’s Name
Recipient's Name
Race / Ethnicity: Used for demographic purposes only
Are you of Hispanic, Latino or Spanish origin?
No
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Other Hispanic, Latino, or Spanish
Do you consider yourself:
Black, African American
American Indian or Alaska Native
Asian Indian
Chinese
Guamanian or Chamorro
Filipino
Japanese
Korean
Native Hawaiian
Samoan
Vietnamese
White
Other Asian
Other Pacific Islander
Other race
Employment Information
Center Name
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County
Center Phone
Name of the person authorizing your scholarship
First
Last
Email of person authorizing scholarship
Initial date of hire
Month
Day
Year
Current hourly wage
Total hours you work in a week
How many months per year do you work?
How many children are in your classroom or child care home?
How long have you worked in the field of early childhood?
Less than 2 Years
2-5 Years
6-10 Years
10+ Years
What is your current job title?
Teacher
Assistant Teacher
Administrator: center directors, assistant directors, and other administrative staff
Family-Based Professional: home care operator/provider
Non-Teaching Support Staff: e.g. Kitchen or Custodial staff
Nevada Ready! State Pre-K Classroom
Yes
No
What age groups do you teach?
Infants (0-12 Months)
Toddler (13-36 Months)
Preschool (37 Months – PreK)
School Age
Education Background
Employer information is to be completed for the applicant only, unless otherwise noted.
Please check the box that best describes your educational history
No high school diploma
High school diploma/GED
1-year certificate
Associates Degree
Bachelor Degree
Master’s Degree
Doctorate
Your Major
Please check the box that best describes your educational goals:
Earn an Early Childhood Credential
Take a few early childhood courses to obtain or upgrade job-related skills
Earn an Early Childhood, Infant/Toddler or School-Age Certificate
Earn an Early Childhood Associate Degree
Earn an Early Childhood Associate Degree & transfer to a 4-year college/university
Earn an Early Childhood Bachelor Degree
Are you currently enrolled at a community college or university?
Yes
No
If applying for a Bachelor Degree Scholarship, please indicate how many credits you have already completed toward your desired Early Childhood degree:
Graduation Date
Month
Day
Year
Financial Aid Verification
Have you applied for any other financial aid, such as a Pell Grant, Smart Start Grant, scholarships, or student loans?
Yes
No
Source of financial aid
Date of application
Month
Day
Year
Application Status:
AWARDED
DENIED
PENDING
http://www.fafsa.ed.gov/
Professional Goals:
What are your professional and educational goals? Please include short and long term goals.
What challenges do you see in obtaining your degree or certificate?
Statement & Signature of Applicant
I agree.
I attest to the fact that the information I have provided is true and accurate.
Based on this information, I am applying to T.E.A.C.H. Early Childhood® Nevada for a scholarship to
help pay the cost of educational expenses.
By signing below I agree to participate in the collection of data regarding the impact of this scholarship on
income, educational attainment, position changes, and quality of care.
Name
*
First
Middle
Last
Date
Month
Day
Year
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