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.

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?:

Are you currently employed on a full-time or part-time basis by Trilogy Health Services, Paragon, or PCA?:

Are you an employee in "good standing" who demonstrates superior/above average work performance?:

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

How long have you been with the company?

Are you currently a smoker, or do you use tobacco products?:

Previous Awards

Have you previously received at Trilogy Scholarship?

Have you received reimbursement from the Tuition Reimbursement within the last 12 months?

When did you last receive this award?

Amount Reimbursed:

Amount Received:

Degree Information

Proposed Course/Degree is:

Degree

Degree if "Other"

Date of Enrollment

Date Of Completion

Estimated Current Loan Balance

Estimated Annual Cost

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