Senior Care Partner Micro-credential Program Application

Personal Information

Your Name*
Home Address
County of Residence
If you are a Lee County resident, please upload a copy of a Government Issued ID to document county of residence
Please list other names by which you have been known
Place of birth
Nation of citizenship
Birth date*
Highest Degree Received*

(Optional) Florida Gulf Coast University has a commitment to encourage diversity among all persons affiliated with the Senior Care Partner program. The information collected below will assist us in our efforts to monitor our effectiveness in this area. 


Gender
Race (Check all that apply)
Ethnicity

Educational Experience

List colleges and universities attended, where you earned a degree, starting with the most recent.

Please upload an unofficial transcript showing completion of a Bachelor's Degree.

Address
Please upload an unofficial transcript verifying completion of a Bachelor's Degree or higher.*
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NOTE: It is recommended that you also attach a resume in addition to completing the above sections!

College/University #2

Address

College/University #3

Address

Professional or Other Work Experience

1. List your current employment information in the fields below.

2. Upload your current professional resume/CV. List all paid employment in chronological order, starting with the most recent. Please be specific in describing the positions you have held, including full- and part-time. Account for all of your time for a minimum of the past ten years.

Upload Resume/CV showing last 10 years of experience/education*
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NOTE: It is recommended that you also attach a resume in addition to completing the above sections!
Upload a letter of support from your current employer or a professional reference from a former instructor/employer*
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File uploads may not work on some mobile devices.
NOTE: It is recommended that you also attach a resume in addition to completing the above sections!

Personal Narrative

 

The purpose of the personal narrative is to provide you with the opportunity to tell the Admissions Committee your reasons for choosing to enroll in the Senior Care Partner program. 

 

The narrative should include:  

· An explanation of your personal background including what has influenced your choice of this program. 

· A self-reflective evaluation of your motivation and preparedness to participate in the Senior Care Partner program. 

· A description of your career goals as they relate to your participation in the Senior Care Partner program.  

This narrative should be at least 500 words in length, double-spaced, with attention to grammar and spelling, organization, and clarity of presentation.

Upload Essay*
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Application Certification Statement


IMPORTANT! APPLICANT MUST READ AND SIGN THE FOLLOWING STATEMENT 

 

By signing this statement, I certify that:  

I understand that this application is for enrollment into the Senior Care Partner program only and is valid only for the term indicated on page 1 of this application. 

I certify that all the information given in this application is complete, accurate, and true, and if  admitted, I hereby agree to abide by the policies of the Board of Trustees and the rules and regulations currently found on the FGCU website (https://www2.fgcu.edu/generalcounsel/regulations.asp). 

I authorize the release of information concerning my academic progress to educational institutions for research study purposes. 

I will notify the Coordinator of the Senior Care Partner program of any changes in the information I have given prior to my entry into the University. 

I understand that I must secure professional liability insurance prior to my placement in the field internship.

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