Memorial Health Colleagues
Memorial Health colleagues currently receiving tuition assistance are NOT eligible to apply.
Please indicate if you are:
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Applicant Information
Applicant's Name
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Permanent Address
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Home Phone
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Cellphone
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Address at college
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Email
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Educational Background
High School Attended
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Year of Graduation
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H.S. Grade Point Average
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H.S. Class Rank
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ACT/SAT Score
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Offices Held, Academic Achievements or Awards Earned in the Last Two Years
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Educational Institution Applicant Will Be Attending
College/University Name
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City and State
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Major/Field of Study
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Year in College
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Cumulative Grade Point Average
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Semester Hours Completed
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Financial Information
Please break down the cost of your schooling for the next school year.
Tuition & Fees
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Books
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Room & Board
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Other Costs
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Total Cost of School
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Explain (Example: work, savings, etc.)
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Describe any personal or family circumstances which you feel should be brought to the attention of the scholarship committee.
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Completed and signed application File is required
High school transcript File is required
Two letters of recommendations
First letter of recommendation File is required
Second letter of recommendation File is required
Proof of enrollment (Copy of acceptance letter or copy of fall class schedule) File is required
Essay (Maximum 300 words) What do you hope to accomplish with your education? What has influenced your decision to enter the healthcare field? How will this scholarship assist you in your educational pursuits? File is required
E-Signature (Full Name)
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