M. J. TOLEN SCHOLARSHIP FUND
Provide the following information on separate
paper. Maximum 3 pages, double spaced. Provide 3 copies of application
in application packet.
I. PERSONAL INFORMATION
(Non-discrimination Policy: Personal Information
will not influence eligibility)
Level of Education____________________________Current
II. COURSE OF STUDY INFORMATION
of Study Desired
Number of hours
Duration of course
of organization offering the course
of the course
the course offer educational credits or contact hours? If so, how
many? Please describe.
the name of the Approver and Provider, if applicable.
a professional association support this educational program? If
yes, which one(s)?
III. APPLICATION QUESTIONS
your interest in Complementary Therapies in End-of-Life Care (CTEOLC).
you studied other complementary therapies? If so, what, when, with
you practice complementary therapies? If yes, do you practice them
personally or professionally?
professionally, do you do so in a private practice setting or under
under your employer, what is the name of your employer?
- Do you currently work with End-of-Life Care?
If yes, what type of setting (hospital, hospice, nursing
home, private practice, volunteer)?
you are employed and work in End-of-Life Care, what organization
are you employed by?
you do not currently practice CTEOLC, how do you plan to use Complementary
Therapies in End-of-Life Care?
will you use this course of study for which you are applying for
has influenced you to pursue this study?
are your goals for taking this course?
IV. FUNDING SCHEDULE - CHOOSE CYCLE
1. Note which Cycle Number and year you are applying
for (i.e. Cycle #1, 2004)
- The funding schedule offers 2 cycles per year
with awards of 2 scholarships per cycle.
- Applicants can apply for up to $250 per course
- Recipients may re-apply in future funding cycles.
- Scholarship funds will be distributed directly
to the educator or institution.
- Scholarships will be utilized exclusively for
coursework, excluding course materials.
Application Deadline Decision Notification
Cycle #1 November 1 December 1 January 1
Cycle #2 July 1 August 1 September 1
Applicant must send 3 copies of the application
by the application deadline to:
MJT Scholarship Fund c/o Peaceful PassagesTM
214 Provincetown Road
Cherry Hill, NJ 08034