Employee Education Assistance Form
Please note the following program considerations:
Only education programs that result in degrees are eligible for the Employee Scholarship. If you are pursing a Certification please apply for the Certification Assistance Program.
Employees can receive either an
Employee Scholarship (planning to go or currently in school)
or
Student Loan Repayment (graduated and not in school).
An employee cannot be eligible for both program simultaneously.
Application Information
Select an answer below to see which program you may be eligible for.
Please select...
I am currently in school or I am looking to enter school soon
I have graduated with my degree and I am no longer enrolled in school
You may select the program below if you meet the requirements:
Apply for Employee Scholarship
-
You must be a White Badge (6 months tenure or greater), work 20+ hours/week, and pursuing (interested or enrolled in) a degree program. An employee is eligible to receive one Employee Scholarship every 12 months.
You may select the program below if you have earned your degree and you are not enrolled in school:
Apply for Student Loan Repayment
- You must be a White Badge (6 months tenure or greater), work 20+ hours/week, have already earned a degree, and no longer be enrolled school. Recipients will receive $100 per month until the loan is paid off while maintaining eligibility requirements.
Eligibility Information
Have you been employed by Trilogy Health Services, Paragon, or PCA for a minimum of six (6) months?:
Please select...
Yes
No
Are you currently employed on a full-time or part-time basis by Trilogy Health Services, Paragon, or PCA?:
Please select...
Yes
No
Are you an employee in "good standing" who demonstrates superior/above average work performance?:
Please select...
Yes
No
Applicant Information
Applicant Name
Employee SSN
The - symbol must be used between the groups of numbers. E.g. 111-11-1111. Error 1.1 would signify an invalid SSN or invalid formatting.
Email Address
Please confirm that the Email submitted is correct and active. Potential award communication will be sent to this address.
Cell Phone
Trilogy Annual Wage
Please select...
Less than $30,000 (less than $15.38 per hour)
$30,000 - $49,999 ($15.39 - $25.64 per hour)
$50,000 - $74,999 ($25.65 - $38.46 per hour)
$75,000 - $99,999 ($38.47 - $51.28 per hour)
$100,000+ (more than $51.29 per hour)
How long have you been with the company?
Please select...
5+ Years
2-4 Years
1-2 Year
6 Months – 1 Year
Less than 6 months
Are you currently a smoker, or do you use tobacco products?:
Please select...
Yes
No
Previous Awards
Have you previously received at Trilogy Scholarship?
Please select...
Yes
No, but have applied
No
Have you received reimbursement from the Tuition Reimbursement within the last 12 months?
Please select...
Yes
No
When did you last receive this award?
Please select...
Fall 2014
Spring 2014
Fall 2013
Spring 2013
Fall 2012
Spring 2012
Fall 2011
Spring 2011
Other
Amount Reimbursed:
Amount Received:
Degree Information
Proposed Course/Degree is:
Please select...
Job Related
Career Related Undergraduate
Career Related Graduate
School Name
Degree
Please select...
BSN
Culinary Arts
MBA
NP
OT
OTA
PhD
PT
PTA
RN
Other
ASN
Degree if "Other"
Date of Enrollment
Date Of Completion
Estimated Current Loan Balance
Please select...
1000-4999
5000-9,999
10,000-24,999
25,000+
Estimated Annual Cost
Please select...
$999 or Less
$1000 - $2,500
$2,500 - $5,000
$5,000 - $10,000
$10,000+
Short Answer
Describe what Customer Service means to you and give an example of when you went above and beyond in serving a customer.
Contact Information