Cincinnati Children's Scholars Program 2020

Cincinnati Children's Scholars Program 2020

Thank you for your interest in the Cincinnati Children's Scholars Program. Your application, faculty recommendations, and GPA will be included in the application review. The completion of this application indicates your consent for the sharing of these materials with the parties involved.
Date

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Personal Information
Applicant Name*

First NameLast Name
Permanent Address if Different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone Number*

Area CodePhone Number
School E-mail Address*
High School Attended*
High School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
School Information
UC Blue Ash NursingCincinnati State
What is your current cumulative GPA? (NOTE: GPA's will be verified and shared during the application process)*
YESNO
Where did you complete your pediatric experience (agency and unit)?*
Expected year and month of graduation*
Why do you want to be a pediactric nurse?*
How have you overcome obstacles and challenges and what lessons did you learn from those experiences that will help you succeed as a pediatric nurse?*
How do you see incorporating the Cincinnati Children's Hospital Medical Center four care promises (see below) into your role as a registered nurse?*
Additional Information
MaleFemaleOther
YESNO
YESNO
WhiteBlack or Afican AmericanAmerican Indian or Alaska NativeChineseFilipinoAsian IndianVietnameseKoreanJapaneseOther AsianNative HawaiianSamoanChamorroOther Pacific Islandersome other race
Employment History
YESNO
What unit do you work in
YESNO
If yes, identify your employer, job title, and years of service
Faculty recommendation form directions: Download and send to the faculty member who oversaw your clinical experience at a CCHMC site. Your faculty member will submit directly to your department chair for inclusion in your application.
Background Check
Please print the document below and have it filled out. This will need to be attached to your form before submitting this application.
Upload the completed criminal background check disclosure. *

Upload a File

Cancelof
Should be Empty: