Reach for the Stars Nursing Scholarship Program

Employee Name:(Required)

Employee ID:(Required)

Personal Phone #:(Required)

Personal Email:(Required)

Work Email:(Required)

Work Phone #:(Required)

Employee Hire Date:(Required)

Employment Status:(Required)

Full-time

Part-time

PRN

Current Performance Rating:(Required)

Have you completed all pre-requisites for nursing school? If not, are you in the last semester of your pre-requisites?(Required)

Yes, I have completed all pre-requisites.

No, I have not completed all pre-requisites; I am not in the last semester of pre-requisites.

No, I have not completed all pre-requisites; I am in the last semester of pre-requisites.

Current GPA:(Required)

Name of the Nursing School at which you are enrolled in or have been accepted to:(Required)

Expected Graduation Date:(Required)

Do you qualify for in-state tuition rates?(Required)

Yes

Current Unit/Department:(Required)

Current Manager:(Required)

Grady Manager/Supervisor Name:(Required)

Grady Manager/Supervisor Email:(Required)

Professional Reference Name:(Required)

Professional Reference Email:(Required)

Personal/Professional Reference Name:(Required)

Personal/Professional Reference Email:(Required)

Personal Statement:(Required)

Directions: Please provide a personal statement on why you should be chosen for this scholarship program. Your statement is limited to 500 words.

Official College Transcripts/Nursing School Admittance Letter (if applicable):

Drop files here or

Max. file size: 50 MB, Max. files: 2.