Recertification Scholarship Application
Scholarship Details
Through a grant from the Wisconsin Department of Transportation, limited scholarships are available for the Child Passenger Safety Technician/Instructor recertification fees for individuals who are not part of an organization that will cover these fees. All recertification requirements must be completed before submitting your application for the recertification scholarship. Applications must be approved prior to finalizing your renewal on the national certification site. CPS Technicians/Instructor Candidates: $55 scholarship will be available for those who meet the eligibility criteria. CPS Instructors: A $60 scholarship will be available for those who meet the eligibility criteria. We reserve the right to limit the number of scholarships awarded to an individual organization to ensure support in all counties and organizations.
Up to 2 scholarships per organization may be approved in our fiscal year- October 1 through September 30.
Name
*
First Name
Last Name
Email
*
example@example.com
Registrant Organization
*
Registrant Title/Position
*
Technician/Instructor ID Number
*
Technician/Instructor Expiration Date
*
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Month
-
Day
Year
Date
Scholarship Eligibility
Applicants must meet these criteria to be eligible
Enter the date of one car seat installation activity you completed with an instructor present during your current certification cycle
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Month
-
Day
Year
Date
Enter CPS Instructor name
*
Enter the date of a 2nd car seat installation activity you completed with an instructor present during your current certification cycle
*
-
Month
-
Day
Year
Date
Enter CPS Instructor name
*
Enter the date of the 3rd car seat installation activity you completed
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Month
-
Day
Year
Date
Enter the date of the 4th car seat installation activity you completed
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Month
-
Day
Year
Date
By checking this statement, you acknowledge that you have completed the eligibility requirements
*
I am a technician/instructor who lives in WI
Please explain how your certification will be used outside your own agency to help in the community
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Submit
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