SRC Living Legacy Foundation
Student Education Grant Application Form

The Living Legacy Foundation provides student Education Grants for SRC employees or the children of employees. The applicant must be enrolled in a course of study (full or part time) in either a recognized two year college or a recognized four year university and be a student in good standing, or enrolled in a course of study leading to a CNA or other healthcare certificate at an institution approved by the SRC Health Center Director. The qualifying employee (i.e. the applicant or the parent of the applicant) must be employed at least half time at SRC and must have been employed by SRC for at least 6 months in order to qualify.

Please fill out all the required fields on this form, select your suppporting files, then click on the Upload your application button at the bottom of the form to upload your information to our server. When your information has been uploaded an email link will be shown. Please submit your application using this email link.

* indicates a required field for the applicant
*** indicates a required field when the qualifying employee is a parent of the applicant

Applicant (Student) Information
Prefix and last name:	*
Preferred pronoun and first name:	*
Address (Street, Apt., City, County, State, Country if not US):	*
Phone:	*
E-mail:	*
College/university (to be) attended and type:	*
Major, or proposed course of study:	*
Present educational level:	*
PayPal Payment ID (please also attach an electronic copy of your PayPal QR code):	I do not have a PayPal account, please mail me a check to the above address.
Please list the years (if any) in which you have previously received a grant from the SRC Living Legacy Foundation.
Qualifying Employee (Student or Parent of Student) Information *** required field if the applicant is a child of the qualifying employee
Relationship to applicant:
Last name:	***
First name:	***
Phone:	***
E-mail:	***
SRC Department:	*
Years and months (if less than two years) employed at SRC:	*
References Please provide the full name, telephone number and email address of two persons whom we may contact to request a reference on your behalf.
Name:	*
Phone:	*
E-mail:	*
Name:	*
Phone:	*
E-mail:	*
Supporting information files Your files will be uploaded when you click on the Upload your application button below.
Statement of personal goals	Please select a MsWord or pdf file *
Proof of current enrollment (e.g. the transcript from your college or university)	Please select a pdf or jpeg or png file *
PayPal Payment ID	If you have PayPal account, please upload a file (png, jpeg or pdf) of your PayPal QR code
Further information (CNA applicant, please upload a copy of the SRC Health Center CNA student form)	If you wish to submit another file with further information to support your application, please upload it here:
Please check that you have provided all required information before clicking the Upload your application* button* Note that it can take some time to upload your files, please be patient. Thank you.

SRC Living Legacy Foundation Student Education Grant Application Form

SRC Living Legacy Foundation
Student Education Grant Application Form