Skilled US Scholarship Interest

This form collects basic information from individuals interested in eligible programs to help connect them with relevant opportunities and resources. Completing this form does not guarantee scholarship approval. Applicant will be notified only if scholarship is approved. Approval is determined by SKILLED US, not Nursing Detroit.

Student's First Name *

Student's Last Name *

Student's Email *

Do you receive SNAP benefits? Do you live OUTSIDE of Detroit. (To be eligible you must receive SNAP benefits AND live outside Detroit, but in Wayne County) *

Yes, I receive SNAP Benefits. Yes I live OUTSIDE of Detroit.

No, I do not receive SNAP Benefits so I am not eligible.

I live in Detroit so I am not eligible.

What city do you live in? *

Student's Date of birth

Student's Phone *

Student's Age *

Do you have a valid government-issued ID? *

Yes
No
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Which Program Are You Interested In? (Select all that apply) *

Phlebotomy (4-Week Classes/ Hybrid Evenings (4pm- 9pm; Meets 3 days online; 1 day in-person)

CNA (3 Week Hybrid Classes-13 Days (4 online Days, 9 In-person Days)

Which CNA class dates are you interested in (Pick all that apply) *

Feb 2 - Feb 18, 2026

Mar 2 - Mar 18, 2026

April 6 - April 27, 2026

April 27 - May 13, 2026

June 1 - June 17, 2026

Select a Class Time: *

CNA Day Classes (0800am-2:30pm)

CNA Afternoons (11:30am- 5:30pm)

Phlebotomy Evenings (4pm-9pm)

Select a Class Type: *

In-Person

Hybrid (combo of online & in-person)

Who referred you?

Additional Information:

Please add any additional information that may help us ensure that we understand your needs.

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