Scholarship Application

Name:

Address:

Telephone:

Email:

Are you an employee of Saint Mary's? Yes No

Which Department:

Is a family member a Saint Mary's employee: Yes No

Which Department:

High School graduated from or High/School attending?

College currently attending:

GPA:

School of Choice: (Where you have been accepted to an RN program)

Degree:

Bachelor of Science Associate of Science

Volunteer/
Community Activities:

Personal Interests:

Why are you choosing a healthcare career? (Be specific). Please write a 300 word essay and attach to application.

Please attach 3 letters of reference (not family members): 1 personal, 1 faculty and 1 employer, if currently working. If not working, someone in a supervisory position or someone knowledgeable of your volunteer service, athletic or extra curricular activities.

Please attach an official transcript from both high school and college (if currently attending).

*Finalists are expected to participate in an interview process.

Any questions, please call Nancy Miko at (203) 709-3031. Please return application to Nancy Miko by March 17, 2008 at Saint Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706.

SCHOLARSHIP APPLICATION