BMC Nursing Scholarship Application

BMC Scholarship Committee

208 Pierson Ave, Centreville, AL, 35042

scholarships@bibbmedicalcenter.com

www.bibbmed.com/bmcscholarships

(205) 926.4881
Nursing Scholarship Application Form

Application Window Varies
Read and follow the instructions carefully prior to submitting your application. All winners will be notified via mail or email.

Please contact us via email only with questions at: scholarships@bibbmedicalcenter.com
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 check for accuracy of information.
I. Personal History

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Format: (000) 000-0000.
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you currently a high school senior?

YesNo
What year did/will you receive a high school diploma/GED?
Optional Informations

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where priority consideration will be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender

MaleFemale
Are you a US citizen?

YesNo
Have you ever been employed or volunteered at BMC?

YesNo
If yes, what department?
Date of employment or volunteer service?

MonthDayYear
Date
Do you have family members employed at BMC?

Yes - parentYes - grandparentNo
If yes, please name employee.
Have you ever been convicted of a law violation (other than a minor traffic violation)?
Please check your veteran status.

VeteranChild of a VeteranSpouse of a VeteranNone of the Above
Please check your status at the time of application.

Upcoming high school graduateI will be an incoming college freshman graduating high schoolI am a GED graduate with no college credit hoursHigh School graduate
Are you a first-generation college student?

Yes, I am the first among my parents or grandparents to attend college.No, my parents or grandparents have attended college.
Major Area of Study
Please indicate what is your major of study
What is your career objective?

0/300
Have you submitted an application for admission?

YesNo
What college or university have you been accepted to?
II. High School Information
Are you currently or will you be a high school graduate this Spring?

YesNo
High School Attended
Year of High School Graduation or GED
Most recent cumulative GPA
High School activities, community activities, volunteer work, honors, offices held
III. 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.
IV. For Current College Students Only
Most recent college attended and cumulative transfer GPA
V. For Students Currently Enrolled in College and Interested in Practical Nursing Program
Approximate credit hours completed:
Current GPA
If applying to the BIBB CAMPUS - Shelton State Nursing Program, have you completed the following courses?

Math 100English 101Biology 103ACT Score of 18 or greater
School activities, honors, offices held, etc.
VI. Extras
Please check each of the qualifiers below that apply to you. This data may increase your likelihood of qualifying for selected scholarships. Please note, if you are awarded a scholarship based on any of these qualifiers, you will be asked to produce documentation verifying your unique eligibility.
Have you ever received a scholarship from BMC?

YesNo
Do you plan to complete a 4-year degree?

YesNo
In addition to a scholarship, would you like to be considered for co-op opportunities (working part-time for tuition support with company relevant to your major)?

YesNo
Will you be working while attending classes?*

YesNo
If so, will you work

Full-timePart-time
Employment History
Employer:
Job Title:
Supervisor:
Dates of Employment:
Job Duties:
VII. Essay
Your essay should be 300-500 words. You should address in your essay: 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. Documentation Required
Copy of Acceptance Letter

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Official Transcript

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Letter of Recommendation (1)

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Letter of Recommendation (2)

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Detailed List of the expenses associated with your course of study.

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Recent Photo

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VIII. Applicant's E-Signature
By signing 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.
Signature
BMC is committed to equal opportunity in employment and education. We do not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Nursing Scholarship Application Form

I. Personal History

II. High School Information

III. ACT Information

IV. For Current College Students Only

V. For Students Currently Enrolled in College and Interested in Practical Nursing Program

VI. Extras

Employment History

VII. Essay

VIII. Documentation Required

VIII. Applicant's E-Signature