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ST. VINCENT ALUMNI ASSOCIATION SCHOLARSHIP / FUNDS APPLICATION

PLEASE READ THE SCHOLARSHIP CRITERIA BEFORE FILLING OUT APPLICATION
(CLICK ON THE "SCHOLARSHIP" BUTTON ABOVE TO VIEW CRITERIA).
If Applying for Tuition:
Completely fill out the application, sign and date. Provide a copy of the most recent UNPAID tuition bill, CURRENT transcript of grades, and a stamped and addressed envelope made out to the University/College.

If Applying for Continuing Education/certification reimbursement:
Completely fill out the application, sign and date. Provide a copy of the conference flier/certification documentation, proof of payment (alumni does not pay for transportation, parking or meals), certificate with CE's awarded/copy of certification renewal and a stamped self addressed envelope.
*Dues must be paid if you are an alumni applying for a scholarship.
Mail everything requested to the address below.
*Please Print!
NAME: _________________________________________________________________________________

ADDRESS_______________________________________________________________________________

CITY___________________________________________________________STATE__________________

ZIP______________ PHONE____________________________ DATE OF BIRTH____________________

NURSING STATUS:STUDENT____RN____EMPLOYER________________________________________

NURSING SCHOOL _____________________________________ GRADUATION YR. _______________

CURRENT STUDENT LEVEL (FRESHMAN, 2nd YR, etc.)____________________ GPA______________

COLLEGE NAME________________________________________________________________________

COLLEGE PHONE #______________________________________________________________________

COLLEGE ADDRESS ____________________________________________________________________

COLLEGE ID NUMBER___________________________________________________________________

IF CE'S, TITLE OF PROGRAM/CERTIFICATION______________________________________________

_______________________________________________________________________________________


DATE_________________________________________COST____________________________________

DO YOU RECEIVE ANY OTHER FINANCIAL ASSISTANCE/FUNDING? YES________NO_________

IF YES, WHERE AND AMOUNT___________________________________________________________

RELATED TO AN ALUMNI MEMBER? Yes______ No_______

ALUMNI NAME: FIRST__________________________ MAIDEN_______________________________

LAST_______________________________________________ GRADUATION YEAR _______________

APPLICANT NAME ____________________________________________________________________

SIGNED________________________________________________________DATED_________________

EMAIL (REQUIRED)_____________________________________________________________________

MAIL TO: TINA BADEN
9860 N. BLUE PRAIRIE DR
WHITEHOUSE, OH. 43571
tina.baden@promedica.org