Scholarship(s) Application Form

Personal Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian/Spouse Name

First NameLast Name
Parent/Guardian/Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Parent/Guardian/Spouse Name

First NameLast Name
Additional Parent/Guardian/Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I have been notified that I will be receiving partial or full financial aid as a college student athlete
Educational Background
Please select any that apply to you.
Are you currently enrolled in high school or college?
Name of Current High School or College:
High School or College Graduation Date:

MonthDayYear
Current High School or College Cumulative GPA:
College Attending Fall 2026:
City College Located In
Anticipated Degree
Primary Areas of Study
Secondary Areas of Study
Work Experience
Are you currently employed by St. Anthony Regional Hospital?
If yes, what department:
Have you ever been employed by St. Anthony Regional Hospital?
If yes, when and what was your position:
Does a member of your immediate family work at St. Anthony hospital?
If yes, please provide the first and last name of the person you are related working at St. Anthony Hospital:
Do you intend to seek employment at St. Anthony Regional Hospital and Nursing Home in the future?
Are you presently working?
Current/Previous employment (Business, Town, Position, Supervisor):
Please list up to 3 current/previous employers.
References

Please list two (2) references (not family members) who will send a written recommendation on your behalf:
Name

First NameLast Name
City
Occupation
Name

First NameLast Name
City
Occupation
This Application Must Include:
1. Completed application form
2. An essay, no more than three (3) pages which includes: a) your career goals, b) where you will be in six months and where you think you’ll be in five years or beyond, c) the background you bring to a healthcare career, d) who is a role model and why they have influenced you, e) your strengths and weaknesses, f) your willingness to work in a rural community healthcare setting. Also, explain any other issues you believe we should consider such as: community service, educational accomplishments, financial needs, family issues, personal goals, commitment to working in the local area, hobbies and interests, etc.
3. Two letters of recommendation sent to the address below, usually written by the two references above. These can be sent via email to foundation@stanthonyhospital.org, or mailed to the address below and will be placed with your application when received.
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Personal Information

Educational Background

Work Experience

References

This Application Must Include: