St. Elizabeth Healthcare Scholarship Application Form

St. Elizabeth Healthcare Scholarship Program

Application Deadline – Friday, January 31, 2025
This $2,000 scholarship is available to high school seniors pursuing a degree in the healthcare field: including public health, biochemistry, nursing, medicine, behavioral, occupational health, environmental health, quality, safety or other health-related disciplines.

Scholarship awardees will be notified on March 1, 2025.

Awardees will be recognized at the NKY Excellence in Education Celebration on April 22, 2025.

Note: If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization, and punctuation.

If you have questions about the scholarship application, please contact Shantae Sandoval at shantae.sandovol@stelizabeth.com.
I. Personal Data

Tell us about yourself.
Full Name*

First NameLast Name
Preferred Name*
Birthdate:*

MonthDayYear
Cell Phone Number:*

Area CodePhone Number
E-mail Address:*
Where the confirmation will be send to
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent / Legal Guardian Name:*
Parent / Legal Guardian Cell Phone Number:*
Parent / Legal Guardian E-mail Address:*
Parent / Legal Guardian Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a U.S.citizen?*

YesNo
Optional Information:

Applicants are invited to voluntarily self-identify their gender, citizenship status and race. Submission of this information is voluntary and refusal to provide it will in no way affect your selection for college scholarship awards. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations.
Gender:

MaleFemalePrefer Not to SayOther
Race: (choose one or more)

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhitePrefer Not to Say
II. Academic Information
Are you a first-generation college student?*

Yes, I am the first among my parents or grandparents to attend college.Either my parents and/or grandparents have attended college.
Major Area of Study:*
Please indicate what is your major are of study
What is your career objective?*

0/300
Medical Field Interest:*

BehavioralBiochemistryEnvironmental HealthMedicineNursingOccupational HealthPublic HealthQualitySafetyOther Health-Related Disciplines
What two schools are you looking at?*
III. High School Information
Year of Expected High School Graduation or GED:
Most Recent Cumulative GPA:
High School Activities, Community Activities, Volunteer Work, Honors, Offices Held:
High School Attending:*
IV. ACT Information
Year You Took the ACT:
ACT Composite (Overall) Score:
ACT scores are not required for scholarship eligibility. However, providing an ACT score can increase the likelihood of your selection as compared to other candidates.

All scholarship applicants reporting an ACT score will be asked to provide official verification.
V. Other Information
Does a parent or relative work at St. Elizabeth Healthcare or St. Elizabeth Physicians?*

YesNo
If yes, please provide name and relationship.
VI. Applicant's Picture

Please only upload pictures in a .jpg, .jpeg, .png, or .gif format. The picture cannot exceed 500 KB in size.
Browse Files

Cancelof
VII. Essay
Your essay should be 300-500 words. Please address in your essay: what led you to the healthcare field, your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics or experiences that make you uniquely worthy of scholarship consideration.
Essay:*

0/500
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the Submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
St. Elizabeth Healthcare and St. Elizabeth Physicians do not discriminate in admissions, employment, or in any of their educational programs or activities on the basis of race, color, national or ethnic origin, ancestry, age, religion or religious creed, disability or handicap, sex or gender (including pregnancy and childbirth), sexual orientation, military or veteran status, genetic information or any other characteristic protected under applicable federal, state or local law.
Should be Empty:

I. Personal Data

II. Academic Information

III. High School Information

IV. ACT Information

V. Other Information

VI. Applicant's Picture

VII. Essay

VIII. Applicant's E-Signature