SGH TUITION ASSISTANCE PROGRAM APPLICATION

SGH Tuition Assistance Program Application Click here to read the policies and guidelines.

Last Name: __________________________ First Name: ____________________

Position/Job Title

________ Full Time SGH Employee________ Part Time SGH Employee________ Not Currently Employed by SGHHome AddressStreet _______________________________________________________________City _____________________________________ State ____________ Zip _______Telephone: ____________________________ Email :_________________________Name of School You Plan to Attend: _______________________________________School Address: _______________________________________________________Expected Graduation Date: ____________ Expected Program Cost : $ _________

Amount you are requesting: $_____________ Date Needed: _________________Check One:___ Degree Program Specify: No. Years for Degree Completion: _________ Certification Program Specify: No. Years for Degree Completion: ______

___ Non- Degree Program Specify: No. Years for Degree Completion: ______

Course Title/Description and Number of Credits		Cost of Course
		$
		$
		$

Description of Other Course-Related Expenses
		$
		$
		$

Lab or Other Costs		$
		$
		$

Total Funding Amount Requested on This Application		$

Attachments:

1. Briefly explain your educational goal and its benefit to SGH.

2. Include any information on what you have already done in working toward your goal.

3. Attach your CV, letters of recommendation, and a history of your community involvement.

I hereby confirm that the stated information is correct.

Signature of Applicant: ____________________________ Date: ________

Applications are due the 15th of February, May, August and November. Please send completed application with back-up documentation* to: SGH Tuition Assistance, Laurie Rockwell, 607 West Main Street, Grangeville, Idaho 83530Call 983-1700 extension 116 with questions.

* Back-up documentation includes proof of costs associated with funding request and previous term’s grades.

Contact Laurie Rockwell, SGH Foundation Director, For more information on the Tuition Assistance Program. EMAIL or Telephone (208)983-1700 extension 116