Employee Education Scholarship Application Step 1 of 2 50% NameThis field is for validation purposes and should be left unchanged.Employee InformationFirst Name(Required)Last Name(Required)Street Address(Required)Phone(Required)Alternate PhoneCity(Required)State(Required)Zip Code(Required) Educational InformationUniversity/College Name(Required)Degree or Certification you wish to achieve(Required)Address(Required)Phone(Required)City(Required)State(Required)Zip(Required)Completion Date(Required) MM slash DD slash YYYY Any additional informationDisclaimer and SignatureEmployee Signature(Required)OCHC(Required) YES, I have worked at OCHC for at least 6 months.Date(Required) MM slash DD slash YYYY Electronic Signature(Required) YES, I declare that the above information is correct & approve this as my electronic signature.
