Apply Today - T.E.A.C.H. Early Childhood® Nevada

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Home Phone*

Home Phone

Cell Phone

Email

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

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:

Employment Information

Center Name

Address

Street Address Address Line 2 City State ZIP Code

County

Center Phone

Name of the person authorizing your scholarship

First Last

Email of person authorizing scholarship

Initial date of hire

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

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

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