Bea Dunstone Application Form

Bea Dunstone Application Form

For Victoria Hospital Support Staff
Incomplete applications or ineligible applications will not be considered.
Name

First NameLast Name
Email
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

City Province

Postal Code
Victoria Hospital Work History
Name of Current Department/Program:
Name of your Current Position:
Current Employment Status
Employment History at Victoria Hospital :
Number of Years
What are your employment goals?
Course 1:
The name of this course is: .
The educational institution is:      .
The course begins on:   Date  and ends on:   Date    .
The tuition for this course is $:     .
Describe how this course could help you in your career with the hospital:
Course 2:
The name of this course is: .
The educational institution is:      .
The course begins on:   Date  and ends on:   Date    .
The tuition for this course is $:     .
Describe how this course could help you in your career with the hospital:
Total Tuition Requested $
Please attach official documentation from the educational institution indicating your name,course/program, dates, and amount of tuition.

Cancelof
Please provide correspondence from your supervisor describing your work ethic and a description of how this course will benefit the hospital.

Cancelof
Terms of the Contract
I hereby certify that the above information is correct.

Agree
If awarded the scholarship, I understand the funds will be paid to me after successful completion of the course.

Agree
I understand I need to submit my transcript and receipts within 60 days of course completion.

Agree
Date Signed by Applicant

MonthDayYear
Date
Should be Empty: