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Phyllis A. Fazzio Scholarship Application

This is the application form for the Phyllis A. Fazzio Scholarship program at Thom Child and Family Services. The program is designed to encourage and support employee development in two distinct training areas: advanced clinical skills, and leadership and management skills.

The scholarship program is selective and there are no guarantees of funding. Please provide as much detail as possible in your responses to ensure the review committee can make informed decisions.

If you encounter technical issues completing the application, or need further guidance, please contact the Training Department (508-655-5222 x139).  
1. Employee Contact Information
Provide one where you are easiest to reach. This question requires a valid email address.
Phone NumberUse this format: 111-222-3333
This question requires a valid number format.
5. Certification for Early Intervention Specialist (CEIS) status:
Space Cell YESNO
I have submitted.
I have been awarded.
6. Are you in a position of leadership at your program?If 'Yes", list your job title and/or describe your role in the Comments section.