2022 Memorial Hospital Scholarships

Question Title

* 1. Contact Info

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Date of Birth

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* 3. Relationship to Memorial Hospital (check any/all that apply)

Memorial Hospital Employee

Memorial Hospital Volunteer

Relative of a Memorial Hospital Employee (son, daughter, or grandchild)

Relative of a Memorial Hospital Volunteer

Student within hospital service area

If you are the son, daughter, or grandchild of an employee or volunteer of Memorial Hospital, what is the name of your parent or grandparent?

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* 4. Scholarships you would like to be considered for

Memorial Hospital Healthcare Scholarships – $1,000 (4 awards available)

Must meet one of the following criteria:

· A graduating high school senior from SAU 9 or MSAD 72 who is entering an accredited health-related field of study.

· An alumnus of SAU 9 or MSAD 72 who is enrolled in an accredited health-related field of study.

· A Memorial Hospital employee who is enrolled in an accredited health-related field of study.

Kathleen Sheehan Memorial Award - $1,000 (1 award available)

Must meet all of the following criteria:

· A student currently enrolled in an accredited health-related field of study program who is a current resident of Carroll County, NH or Western Maine.

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* 5. School for which aid is requested

Name

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 6. High School Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

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* 7. Enrollment Status (upcoming year)

Full time

Part time

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* 8. Upcoming Year in school

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* 9. Field of Study

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* 10. How many credits will you take next semester?

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* 11. Total annual cost for program (including tuition, room & board, books, etc.)

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* 12. Memorial Hospital Employees: do you participate in the MaineHealth tuition reimbursement program?

Yes

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* 13. Amount expected from other funding sources

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* 14. For High School Seniors: What is your Estimated Family Contribution (EFC -from your SAR report)

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* 15. Briefly list relevant school and community activities in which you have participated.

Include the activity, number of years, and any special honors you received.

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* 16. Briefly list any paid work experience you've had in the past four years.

Include the position, the business name/location, period of employment and average hours per week.

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* 17. Please submit a brief essay (less than 500 words) about your career goals.

PDF, DOC, DOCX file types only.

Choose File

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* 18. Please submit documentation of successful completion of previous year of your program OR an acceptance letter to your program if you are a new enrollee.

PDF, DOC, DOCX file types only.

Choose File

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* 19. For High School Seniors: Please upload your high school transcript.

PDF, DOC, DOCX file types only.

Choose File

2022 Memorial Hospital Scholarships

Question Title

* 1. Contact Info

Question Title

* 2. Date of Birth

Question Title

* 3. Relationship to Memorial Hospital (check any/all that apply)

Question Title

* 4. Scholarships you would like to be considered for

Question Title

* 5. School for which aid is requested

Question Title

* 6. High School Information

Question Title

* 7. Enrollment Status (upcoming year)

Question Title

* 8. Upcoming Year in school

Question Title

* 9. Field of Study

Question Title

* 10. How many credits will you take next semester?

Question Title

* 11. Total annual cost for program (including tuition, room & board, books, etc.)

Question Title

* 12. Memorial Hospital Employees: do you participate in the MaineHealth tuition reimbursement program?

Question Title

* 13. Amount expected from other funding sources

Question Title

* 14. For High School Seniors: What is your Estimated Family Contribution (EFC -from your SAR report)

Question Title

* 15. Briefly list relevant school and community activities in which you have participated. Include the activity, number of years, and any special honors you received.

Question Title

* 16. Briefly list any paid work experience you've had in the past four years. Include the position, the business name/location, period of employment and average hours per week.

Question Title

* 17. Please submit a brief essay (less than 500 words) about your career goals.

Question Title

* 18. Please submit documentation of successful completion of previous year of your program OR an acceptance letter to your program if you are a new enrollee.

Question Title

* 19. For High School Seniors: Please upload your high school transcript.

* 15. Briefly list relevant school and community activities in which you have participated.

Include the activity, number of years, and any special honors you received.

* 16. Briefly list any paid work experience you've had in the past four years.

Include the position, the business name/location, period of employment and average hours per week.