Six Sigma Wing
s
for Heroes
US Military & Veteran Online Lean Six Sigma Black Belt Training and Certification Program
Sc
holarship Application Form
Read the IMPORTANT NOTICE
Below
Prior t
o
Completing the Application
IMPORTANT NOTICE:
To apply for the Six Sigma Wings for Heroes (SSWH) scholarship, applicants must meet the qualification criteria described at the SSWH website. The criteria are posted on the "Eligibility & Tuition" webpage. Scholarship recipients are herein referred to as “students." 1) The student will be provided immediate access to all elements, systems and features of the SSWH program upon SSMI’s validation of successful enrollment and tuition payment. 2) The student understands that the Evaluation and Testing System is operated by a third party provider and requires a separate one-time payment to activate (which is not included in the scholarship benefit or program tuition). 3) The student is granted one 30 minute coaching session per week (maximum = 24 sessions). This translates to an average of 2 hours of personalized coaching per month (assuming a typical completion time of 6 months); however, depending on the student's academic skills, retention rate and speed of learning, a given coaching session may not be needed during a particular week. 4) The student understands that its SSMI's policy that allocated coaching hours DO NOT accumulate if not used. Furthermore, the coaching hours cannot be transferred and are not redeemable in any way or form. 5) The student may schedule a coaching intervention at any time; however, the student will adequately prepare for the session by first utilizing the delivery system's supporting features and/or other resources (like Internet-based resources that can be found through search engines). 6) The student understands that every program coach has certain time constraints (like available days and times). If the student attempts to schedule a coaching session, it’s possible that a coach may not be available for the requested time frame. In such cases, it is incumbent upon the student to find and schedule an acceptable time frame. 7) The student is expected to assure appropriate behavior during a coaching session, avoid the use of profanity and practice conventional courtesies. 8) The student is expected to comply with existing and future copyright laws. This means respecting the sovereign intellectual property rights of others at all times under any conditions or circumstances. 9) The student agrees not to disclose any sensitive, confidential and/or propriety information or data that might be provided to the student by another student, coach and/or SSMI. 10) The student agrees to safeguard the intellectual property of other students, coaches and/or SSMI that the student may acquire or otherwise come to hold in their possession. 11) The student agrees to comply with SSMI's polices and standards of ethics as posted at the SSWH website or where otherwise defined. 12) The student understands that SSMI retains the right to expel, discontinue or otherwise restrict (without appeal) any student from the SSWH scholarship program if any of the aforementioned conventions, practices, policies and expectations are not followed or otherwise self-enforced in a conventional and good-faith manner. In this event, the student is due no tuition refunds of any type or form for the current month or any previous month; however, SSMI will immediately discontinue tuition charges for the next current month and any month thereafter. 13) The student will hold SSMI and all of its officers, employees, contractors, sponsors and representatives, as well as other students and program coaches legally harmless in the event of any type of real or perceived damages or harm resulting from his/her participation in the SSWH Scholarship Program or any part thereof. 14) The student agrees that SSMI has made no promises or guarantees related to any aspect of the learning system's performance, academic achievement, program completion, job placement and/or level of future income. 15) The student will provide valid and accurate information to SSMI and its coaches at all times. 16) The student grants SSMI exclusive permission to validate and authenticate any and all information the student provides in connection with the SSWH scholarship application (like verification of military service). 17) The student recognizes that the provision of false information and data will result in automatic termination of all SSWH scholarship benefits and immediate expulsion from the program. In such an event, the student will be liable for the monthly standard retail value of the program less any tuition paid by the student for the total number of enrollment months. The intent of the latter policy is to prevent or otherwise avoid the granting of a scholarship based on falsified inputs from the applicant. 18) The student will answer all SSWH scholarship application questions to the best of his/her knowledge.
Do you understand and agree to all of the terms, conditions, practices, policies and expectations described in the "IMPORTANT NOTICE" provided above?
Yes
No
Do you understand that if your scholarship application is APPROVED, you will have ten (10) business days from the date of submitting this application to activate your scholarship by enrolling into the program; otherwise, your scholarship will be withdrawn and allocated to another applicant.
Yes
No
Applicant Name
Applicant Email
Applicant Phone
Applicant Address
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
_______________________________________________________________________________________
Are you a US citizen?
Yes
No
How did you first learn about the scholarship program?
Website
Press Release
Magazine Advertisement
Magazine Article
Personal Friend
Work Colleague
Family Memeber
Email Notification
Internet Search
LinkedIn
Facebook
Twitter
TV Interview
Radio Announcement
Discussion Board
Trade Conference
Other
What branch of the military are/were you most associated with?
Army
Marine Corps
Navy
Air Force
Coast Guard
Army Reserve
Marine Corps Reserve
Navy Reserve
Air Force Reserve
Coast Guard Reserve
Army National Guard
Air National Guard
What best describes your military status?
Active Duty (Good Standing)
Active Duty (Less than Good Standing)
Reservist or Guard (Good Standing)
Reservist or Guard (Less than Good Standing)
Retired (Honorable Discharge))
Retired (Less than Honorable Discharge)
Veteran (Honorable Discharge)
Veteran (Less than Honorable Discharge)
How many years of military duty have you served?
Less Than 1
1 - 3
4 - 6
7 - 10
11 - 15
16 - 20
Greater than 20
What best describes your current employment status?
Full-Time Military Duty + No Civilian Job
Part-Time Military Duty + Full-Time Civilian Job
Part-Time Military Duty + Part-Time Civilian Job
Part-Time Military Duty + No Civilian Job
Self-Employed (Business Owner)
Full-Time Civilian Job + No Military Duty
Part-Time Civilian Job (1-10 hours per week)
Part-time Civilian Job (11-20 hours per week
Part-time Civilian Job (21-30 hours per week)
Unemployed Civilian (1-6 months without job)
Unemployed Civilian (7-12 months without job)
Unemployed Civilian (13-24 months without job)
Unemployed Civilian (25+ months without job)
Are you a Purple Heart recipient?
Yes
No
How technical is/was your Military Occupational Specialty (MOS)?
Ultra-Technical
Highly Technical
Somewhat Technical
Non-Technical
Who is the scholarship intended for (herein called the beneficiary)?
Myself (Applicant)
Spouse
Son (21 years or older)
Daughter (21 years or older)
Brother
Sister
If the scholarship beneficiary is a family member, then provide the name and email of that person; otherwise skip the next two items.
Beneficiary Name
Beneficiary Email
What is the PRIMARY REASON the beneficiary wants to become a certified Lean Six Sigma Black Belt?
Gain Employment
Increase Income
Change Employer
Get Promotion
Increase Status
Improve Resume
Acquire Knowledge
Help Company
Improve Leadership
Solve Problems
Teach Others
Become Consultant
Other
What is the beneficiary's highest level of formal education?
None
Elementary School
Jr. High School
GED
High School Graduate
Associate Degree
Bachelor's Degree or Higher
What type of Six Sigma training has the beneficiary received in the past?
None
Brief Overview (Classroom)
Brief Overview (Online)
Brief Overview (Book)
Brief Overview (Magazine)
Extensive Overview (Classroom)
Extensive Overview (Online)
White Belt (Classroom)
White Belt (Online)
Yellow Belt (Classroom)
Yellow Belt (Online)
Green Belt (Classroom)
Green Belt (Online)
Black Belt (Classroom)
Black Belt (Online)
Master Black Belt (Classroom)
Master Black Belt (Online)
Six Sigma Champion (Classroom)
Six Sigma Champion (Online)
Is the beneficiary self-motived?
Yes
Somewhat
No
Uncertain
Does the beneficiary work well in a self-directed learning environment (like online training)?
Yes
Somewhat
No
Uncertain
Does the beneficiary enjoy problem solving?
Yes
Somewhat
No
Uncertain
Is the beneficiary capable of sustained effort when working toward a long-term goal?
Yes
Somewhat
No
Uncertain
Does the beneficiary enjoy working on improvement projects?
Yes
Somewhat
No
Uncertain
No Experience
Does the beneficiary enjoy working in a team enviornment?
Yes
Somewhat
No
Uncertain
No Experience
What type of role does the beneficiary most enjoy while working in a team environment or on a project?
Leader
Worker
Advisor
Organizer
Technician
Administrator
Coordinator
Strongly Agree
Agree
Marginally Agree
Disagree
Strongly Disagree
The beneficiary has a working knowledge of basic arithmetic (like addition, subtraction, multiplication and division).
The beneficiary has a working knowledge of basic charts and graphs (like pie chart, bar chart, line graph)
The beneficiary has a rudimentary knowledge of basic statistics (like mean, median, variance, probability, histogram)
What is the current skill level of the beneficiary when working with computers(see above for definitions)?
None
Basic
Intermediate
Advanced
Strongly Agree
Agree
Marginally Agree
Disagree
Strongly Disagree
The beneficiary has a working knowledge of Microsoft Word.
The beneficiary has a working knowledge of Microsoft Excel.
The beneficiary has a working knowledge of Microsoft Power Point.
Provide any other information you would like us to know about when considering your application (150 words or less).
Thank you for your time -- Mikel J. Harry, Ph.D.
Untitled
Verification
Send
Print