Scholarship Application - Little Company of Mary Hospital and ...
Scholarship Application - Little Company of Mary Hospital and ...
Scholarship Application - Little Company of Mary Hospital and ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
LITTLE COMPANY OF MARY HOSPITAL NURSING ALUMNIMONETARY SCHOLARSHIP AWARD APPLICATIONPersonal DataName _________________________________________________________________________Address ________________________________________________________________________City, State Zip ___________________________________________________________________*Student ID Number ___________________________________________________________Home Telephone _(____) __________________________________________________________Please attach a photograph <strong>of</strong>yourself that may be used by theAlumni Association for any <strong>and</strong> all<strong>of</strong> its publications. (A digitalphotograph may be sent via emailto efreyer@lcmh.org)Cell Phone _(____) _______________________________________________________________E-Mail _________________________________________________________________________Educational Background (Present to Past)SCHOOL NAMEAND ADDRESSDATES ATTENDEDFROM TOCOURSE OFSTUDY / MAJORDIPLOMA OR DEGREEWork History (Present to Past)JOB TITLE DATES NAME OF ORGANIZATION ADDRESSPage 1
EssayThe application must be accompanied with a one - page essay stating your goals <strong>and</strong> the purpose <strong>of</strong>your career choice.Page 2
<strong>Scholarship</strong> Information (This should have the School name <strong>and</strong> address to where scholarship money should be sent. e.g. Bursar, Financial Aid Office, etc.)Program <strong>of</strong> study: _____________________________________________________________College / University: __________________________________________________________School Officer Name: __________________________________________________________Address: ____________________________________________________________________________________________________________________________________________________________________________________________________________Telephone: __(____)___________________________________________________________Anticipated Start Date: _________________________________________________________Have you been formally accepted into a program <strong>of</strong> study by the institution indicated above?YES Please attach the letter <strong>of</strong> acceptance with this application.NOWhen do you anticipate a formal decision regarding the acceptance <strong>of</strong> youradmission application? _________________________________________Written Reference/Recommendations(Please provide the names <strong>of</strong> the 3 people who will be providing a reference for you.):1. Relative Alumni: ___________________________________________________ Class Of: ____________________2. Academic: _________________________________________________________3. Work: ____________________________________________________________Cost Information:DescriptionEstimated Amount:Agreement:If awarded, I agree to update my progress to the <strong>Little</strong> <strong>Company</strong> <strong>of</strong> <strong>Mary</strong> Nurses’ Alumni Board._______________________________________________(signature)______________________(date)_______________________________________________(printed name)Interview: A Committee Member will conduct an interview by phone or in person with every applicant prior to determination <strong>of</strong> award.For Office Use Only: <strong>Scholarship</strong> Committee member __________________________________________Page 3
Change language