IN-TIME Scholarship Application Date of Application PERSONAL AND PROFESSIONAL INFORMATION Applicant Name Mailing Street Address City State Zip Email Phone Current Position/Title Date you started in current position Total number of hours you work per week If your current position is supervisory, what is your current direct care FTE? Your Supervisor’s Name EDUCATION College/University Degree Major Graduate School Degree Graduate School Degree APPLICANT AGREEMENT FORM In applying for the IN-TIME Scholarship, I hereby agree to the following (please check each individual box): I grant Connected Beginnings permission to contact my supervisor for references if I am awarded a scholarship. All of the materials submitted as part of this application are true representations of my academic and employment history. Signature Date Please submit the following with your application: Letter of Reference from your program director or other appropriate agency representative, endorsing your participation and agreeing to support your efforts. For self-employed practitioners, a letter from a professional colleague who is familiar with your practice is required. Current resume. to Cathy Abbott either by mail at Connected Beginnings Training Institute, Wheelock College, 200 The Riverway, Boston, MA 02215 or by email at [email protected].