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team-up to offer TEN CAREGIVERS an opportunity to win an Educational Travel Grant

 

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Group Nomination Form

Recommend one outstanding caregiver in your Share The Care™ Group to receive a Road Scholar Educational Travel Grant

Looking for our Caregiver Application Form instead? Click here.

ATTENTION:
The closing date has been extended to: December 31, 2017

 

INSTRUCTIONS

Please read the eligibility requirements and these instructions carefully before nominating someone from your Share The Care group to be awarded a Road Scholar Travel Grant.  Please complete this nomination that will be reviewed by our Share The Care Organization Grant Committee.  All parts of the application must be complete, including the program number and date for which you are applying.

 

BEFORE YOU START, PLEASE HAVE THE CAREGIVER YOU ARE RECOMMENDING VISIT https://www.roadscholar.org/find-an-adventure TO CHOSE THE ROAD SCHOLAR EDUCATIONAL TRAVEL PROGRAM HE OR SHE WOULD LIKE TO BE AWARDED.  THE PROGRAM MUST BE IN U.S. AND COST NO MORE THAN $1,400.  Be sure to copy down program name, number and date to include in this application.

Please answer the questions thoughtfully and thoroughly. The answers will be used to determine eligibility. Incomplete nominations will not be reviewed.

Note: Please remember to sign and date this nomination form at the end of the page.

Please allow 4-6 weeks for us to review your application and send a response.  Winners will be contacted directly by Road Scholar with award letter and enrollment information for their selected program/date.

If you have any questions regarding this nomination form, you may contact us by emailing info@sharethecare.org or by calling (212) 991-9688 Monday through Friday, 10 a.m. to 5 p.m., ET.  All fields are required.

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*All fields are required.

STC Group Nomination Form

STC Group Nomination Form

NOMINATION INFORMATION

All Fields Required!
First / Last

PERSONAL INFORMATION – of caregiver nominated to qualify for a grant

City
State
Zip/Postal
Country

Information of person for whom you provide care:

Program Information

Please provide the following information about the program for which you would like to be awarded:

Nomination Statement

Person making the nomination

By signing this nomination form, you are agreeing to allow Share The Care and Road Scholar to use your nomination story in Share The Care and Road Scholar publications and news releases, and on their websites. You waive any right, title, and interest you may have in the story and agree to their use by Share The Care and Road Scholar for any purposes it would deem necessary and appropriate. Your contact information will always remain completely confidential.
Please digitally sign this application by entering your full name and the date
Sending

Your contact information will always remain confidential

Grants will be available until they are all awarded.
Closing Date Extended to: December 31, 2017

Don’t Wait. Nominate a fellow caregiver today!

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ShareTheCaregiving™ Inc. (aka Share The Care™) a project of the National Center for Civic Innovation (501c3) Inc. is not responsible for any claims of any nature arising out of any individual’s participation in any aspect of the Road Scholar travel program experience.

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