Alpha Chi Chi Chapter – Chi Eta Phi Sorority, Inc. Scholarship Application

Alpha Chi Chi Chapter – Chi Eta Phi Sorority, Inc. Scholarship Application

Application Deadline: October 23, 2025
Applicant Information
Full Name

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile No
Format: (000) 000-0000.
Email
Where the confirmation will be send to
Birthdate

MonthDayYear
Gender
Financial Assistance
Are you currently receiving any other financial assistance or scholarships?
If yes, please specify and include the amounts:
Nursing Program Details
Are you currently enrolled in a nursing program?
Program Name:
Are you a U.S. citizen?
Anticipated Graduation Date:
Unofficial current transcript
File Upload

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Employment Information
Are you currently employed?
Employer Name:
Position:
Hours per Week:
Length of Employment:
Personal Statement

Please attach a typed, double-spaced essay (maximum 2 pages) that covers the following points:
- A brief introduction about yourself
- Your community involvement and/or volunteer activities
- Awards and personal achievements
- Leadership experiences and examples of your leadership skills
- Your career goals
- Reasons why you should receive the Alpha Chi Chi Chapter Scholarship
- How you plan to positively contribute to the healthcare industry as a nurse
File Upload

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Any additional information you wish to share with the Scholarship Selection Committee
Applicant Declaration
PLEASE INITIAL BELOW
Signature of Applicant:
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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Submission Instructions
- Application Deadline: October 23, 2025
- Email completed application to: AXXSTLOUIS@gmail.com
- Unofficial current transcript. This may be an attached photo however current
- transcript date must be present.
Should be Empty:

Alpha Chi Chi Chapter – Chi Eta Phi Sorority, Inc. Scholarship Application

Applicant Information

Financial Assistance

Nursing Program Details

Employment Information

Personal Statement

Applicant Declaration

Signature of Applicant:

Submission Instructions