New Hampshire Bureau of Developmental Services
Scholarships for Courses in the Human Services Certificate Program
The New Hampshire Bureau of Developmental Services (BDS) continues to offer
scholarships for courses leading to a Certificate in Human Services or Community Social
Services. Courses are offered through the following Community College System of NH
locations: White Mountains Community College, River Valley Community College,
Lakes Region Community College, Nashua Community College, and NHTI.
Scholarships may pay the full tuition for each course in the certificate program. Students
are responsible for purchasing books and supplies, and are expected to matriculate at the
College they attend.
Scholarship Eligibility
Employees of agencies receiving funding through The NH Bureau of Developmental
Services, consumers, family members, and others affiliated with a Developmental
Service Provider Agency or an Area Agency (AA) are eligible to apply for the
Scholarships. Eligibility is determined by the local Area Agency within these guidelines.
To Apply For Scholarships, You Should:
1.
2.
3.
Pick up an application package from your local Area Agency or College;
Complete the application and return it to the Community College in your
area, after you have the Nominations page signed by the appropriate
person(s) at the Area Agency
When you are notified of your scholarship award, bring your notification
to Registration. Check with your local College for registration times.
Students who do not receive scholarships from the Bureau of Developmental Services
may be eligible for other financial aid options. Contact the College in your area for more
information.
ADDITIONAL INFORMATION
For specific course offerings and other schedule information, call the local Human
Services program coordinator at the number listed below:
WMCC
RVCC
LRCC
NCC
NHTI
Laurie Carrier
Susan Parry
Linda Ferruolo
Jayne Barnes
Kathy Curran
The Bureau of Developmental Services:
Jan Skoby
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752-1113 x 3019
542-7744 x 5415
366-5231
578-8900 x 1641
271-6484 x4147
lcarrier@ccsnh.edu
sparry@ccsnh.edu
lferruolo@ccsnh.edu
jbarnes@ccsnh.edu
kcurran@ccsnh.edu
271-5061 Jan.T.Skoby@dhhs.state.nh.us
NOMINATIONS AND AUTHORIZATION TO REGISTER
Please circle semester: FALL
SPRING
SUMMER
201_
As part of the process, which will provide you with scholarship support from the Bureau of
Developmental Services, you must submit this form each semester in which you register for a
course/s. This form indicates that you have the support of the Area Agency (AA) in your region
and your employer (if you work for an organization that contracts with one of the AAs ).
You will not be able to register for courses without this form
approved by the College Coordinator.
Applicant Name ________________________________________ Date ___________________
Address _______________________________________________________________________
City ________________________________________________ Zip ______________________
Telephone Number _________________________ (Home) ________________________(Work)
I want to register for the following course/s this semester: ____________________________
____________________________________________________________________________
The signatures below indicate nomination of the applicant for scholarship support.
1.
Developmental Services Area Agency
(Must be signed for all applicants)
Name of Agency/Center ___________________________________________________
Signature of person authorized to approve scholarship ___________________________
2.
If you work for, or are affiliated with an organization that contracts with a NH
Area agency for Developmental Services
Name of The Agency
_________________________________________________________
Signature of Individual
Nominating Applicant ________________________________________
_____________________________________________________________________________
FOR COLLEGE USE ONLY:
1.
The above student is authorized to register for:
College Coordinator _________________________________________________
2.
At the end of the add/drop period, the above student was enrolled in:
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Department of Regional Community Technical Colleges
Human Services / Community Social Services Certificate Program
NH Bureau of Developmental Services Scholarship Program
Dear Applicant:
Thank you for your interest in the Human Services / Community Social Services program. We
ask that you complete this form in addition to the standard Application for Admission to the
College. Please read the following questions carefully and answer as completely as possible.
Return all completed application materials to the college.
I.
Applicant Information
Name _____________________________________ Social Security Number _______________
Address _______________________________________City or Town ___________________
Telephone ___________________________ (Home) _____________________________(Work)
Human Service agency you are currently affiliated with _________________________________
Length of time with the agency _______________________________
Other human services experience (summarize briefly)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
II.
Applicant Goals
The following four questions will help us get to know you as an individual. Please answer
carefully and feel free to use additional paper for your answers:
1.
Why have you chosen to pursue human services as a career?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2.
What qualities or specific skills do you believe you bring to the human services field?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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3.
What are your professional goals? What would you like to be doing in human services
five years from now?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4.
What are your academic goals? How would you use your academic experiences to
achieve your professional goals?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
III.
Acknowledgment of Practicum Policies and Authorization to Release Information
As part of the practicum experience in the Certificate program, you will be expected to
work in human services agencies. Recent policies from various New Hampshire State Agencies
have mandated that human service providers investigate the backgrounds of all employees,
including student interns. As part of this process, a criminal background check will be conducted
by the agency to which you are assigned. The results of this background check will not be used
in the process of accepting applicants into the program, but may impact your practicum
placement. These results may also impact your future employment options. As a practicum
student, you may be asked to pay the nominal fee for this background check.
Additionally, many providers in New Hampshire are required to offer protection from
Hepatitis B, a contagious and sometimes dangerous disease, to all employees, including student
interns. Your placement site may require that you receive this vaccine, or sign a form
documenting that you decline the vaccination and understand the implications of that decision.
Your signature below authorizes the Department of Regional Community Technical
Colleges, the Bureau of Developmental Services, and your specific agency to receive and release
information about enrollment in your academic program. Additional authorization may be
requested to release information about your progress through the program.
Please sign below to indicate that you have read and understand the above statements.
_______________________________________
Name
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__________________________
Date