New Hampshire Bureau of Developmental Services
Scholarships for Courses in the Human Services Certificate Program
The New Hampshire Bureau of Developmental Services (BDS) continues to offer scholarships for courses leading to a Certificate in Human Services or Community Social Services. Courses are offered through the following Community College System of NH locations: White Mountains Community College, River Valley Community College, Lakes Region Community College, Nashua Community College, and NHTI. Scholarships may pay the full tuition for each course in the certificate program. Students are responsible for purchasing books and supplies, and are expected to matriculate at the College they attend.
Scholarship Eligibility
Employees of agencies receiving funding through The NH Bureau of Developmental Services, consumers, family members, and others affiliated with a Developmental Service Provider Agency or an Area Agency (AA) are eligible to apply for the Scholarships. Eligibility is determined by the local Area Agency within these guidelines.
To Apply For Scholarships, You Should:
1. Pick up an application package from your local Area Agency or College;
2. Complete the application and return it to the Community College in your area, after you have the Nominations page signed by the appropriate person(s) at the Area Agency
3. When you are notified of your scholarship award, bring your notification to Registration. Check with your local College for registration times.
Students who do not receive scholarships from the Bureau of Developmental Services may be eligible for other financial aid options. Contact the College in your area for more information.
ADDITIONAL INFORMATION
For specific course offerings and other schedule information, call the local Human Services program coordinator at the number listed below:
WMCC Laurie Carrier 752-1113 x 3019
RVCC Susan Parry 542-7744 x 5415
LRCC Linda Ferruolo 366-5231
NCC Jayne Barnes 578-8900 x 1641
NHTI Kathy Curran 271-6484 x4147
The Bureau of Developmental Services:
Jan Skoby 271-5061
NOMINATIONS AND AUTHORIZATION TO REGISTER
Please circle semester: FALL SPRING SUMMER 201_
As part of the process, which will provide you with scholarship support from the Bureau of Developmental Services, you must submit this form each semester in which you register for a course/s. This form indicates that you have the support of the Area Agency (AA) in your region and your employer (if you work for an organization that contracts with one of the AAs ).
You will not be able to register for courses without this form
approved by the College Coordinator.
Applicant Name ______Date ______
Address ______
City ______Zip ______
Telephone Number ______(Home) ______(Work)
I want to register for the following course/s this semester: ______
______
The signatures below indicate nomination of the applicant for scholarship support.
1. Developmental Services Area Agency
(Must be signed for all applicants)
Name of Agency/Center ______
Signature of person authorized to approve scholarship ______
2. If you work for, or are affiliated with an organization that contracts with a NH Area agency for Developmental Services
Name of The Agency ______
Signature of Individual
Nominating Applicant ______
______
FOR COLLEGE USE ONLY:
1. The above student is authorized to register for:
College Coordinator ______
2. At the end of the add/drop period, the above student was enrolled in:
Department of Regional Community Technical Colleges
Human Services / Community Social Services Certificate Program
NH Bureau of Developmental Services Scholarship Program
Dear Applicant:
Thank you for your interest in the Human Services / Community Social Services program. We ask that you complete this form in addition to the standard Application for Admission to the College. Please read the following questions carefully and answer as completely as possible. Return all completed application materials to the college.
I. Applicant Information
Name ______Social Security Number ______
Address ______City or Town ______
Telephone ______(Home) ______(Work)
Human Service agency you are currently affiliated with ______
Length of time with the agency ______
Other human services experience (summarize briefly)
______
______
______
______
______
II. Applicant Goals
The following four questions will help us get to know you as an individual. Please answer carefully and feel free to use additional paper for your answers:
1. Why have you chosen to pursue human services as a career?
______
______
______
______
______
2. What qualities or specific skills do you believe you bring to the human services field?
______
______
______
______
______
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3. What are your professional goals? What would you like to be doing in human services five years from now?
______
______
______
______
______
4. What are your academic goals? How would you use your academic experiences to achieve your professional goals?
______
______
______
______
______
III. Acknowledgment of Practicum Policies and Authorization to Release Information
As part of the practicum experience in the Certificate program, you will be expected to work in human services agencies. Recent policies from various New Hampshire State Agencies have mandated that human service providers investigate the backgrounds of all employees, including student interns. As part of this process, a criminal background check will be conducted by the agency to which you are assigned. The results of this background check will not be used in the process of accepting applicants into the program, but may impact your practicum placement. These results may also impact your future employment options. As a practicum student, you may be asked to pay the nominal fee for this background check.
Additionally, many providers in New Hampshire are required to offer protection from Hepatitis B, a contagious and sometimes dangerous disease, to all employees, including student interns. Your placement site may require that you receive this vaccine, or sign a form documenting that you decline the vaccination and understand the implications of that decision.
Your signature below authorizes the Department of Regional Community Technical Colleges, the Bureau of Developmental Services, and your specific agency to receive and release information about enrollment in your academic program. Additional authorization may be requested to release information about your progress through the program.
Please sign below to indicate that you have read and understand the above statements.
______
Name Date
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CSS Scholarships revised 04/2013