Undergraduate Scholarship Application

Name:

Address:

Telephone:

Work Home Cell

Email:

Is a family member a Saint Mary's Hospital employee? Yes No

Family member name:

Their department at Saint Mary's:

Name of High School Graduated from or High School you are currently attending:

GPA:	College or University you have been accepted to attend:

Degree: Bachelor of Science Associate of Science

Please refer all questions to Jan Young at nursingscholarships@stmh.org or (203) 709-6094. All completed, printed applications must be submitted in person or mail to Nursing Scholarship Application, Attn: Jan Young, Saint Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706. The deadline for submission for all Nursing Scholarship applications is 4:00 p.m. EST Friday, March 29, 2013.