Memorial Health Colleagues
Memorial Health colleagues currently receiving tuition assistance are NOT eligible to apply.
Please indicate if you are:
This field is required
Applicant Information
Applicant's Name
This field is required
This field needs to be a valid value
Permanent Address
This field is required
This field needs to be a valid value
Home Phone
This field is required
This field needs to be a valid value
Cellphone
This field is required
This field needs to be a valid value
Address at college
This field is required
This field needs to be a valid value
Email
This field is required
Email needs to be a valid email address.
Educational Background
High School Attended
This field is required
This field needs to be a valid value
Year of Graduation
This field is required
This field needs to be a valid value
H.S. Grade Point Average
This field is required
This field needs to be a valid value
H.S. Class Rank
This field is required
This field needs to be a valid value
ACT/SAT Score
This field is required
This field needs to be a valid value
Offices Held, Academic Achievements or Awards Earned in the Last Two Years
This field is required
This field needs to be a valid value
Educational Institution Applicant Will Be Attending
College/University Name
This field is required
This field needs to be a valid value
City and State
This field is required
This field needs to be a valid value
Major/Field of Study
This field is required
This field needs to be a valid value
Year in College
This field is required
This field needs to be a valid value
Cumulative Grade Point Average
This field is required
This field needs to be a valid value
Semester Hours Completed
This field is required
This field needs to be a valid value
Financial Information
Please break down the cost of your schooling for the next school year.
Tuition & Fees
This field is required
This field needs to be a valid value
Books
This field is required
This field needs to be a valid value
Room & Board
This field is required
This field needs to be a valid value
Other Costs
This field is required
This field needs to be a valid value
Total Cost of School
This field is required
This field needs to be a valid value
Explain (Example: work, savings, etc.)
This field is required
Describe any personal or family circumstances which you feel should be brought to the attention of the scholarship committee.
This field is required
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 degree? What has influenced your decision to enter your chosen field? How will this scholarship assist you in your educational pursuits? File is required
E-Signature (Full Name)
This field is required
This field needs to be a valid value