St. John's Hospital

Scholarship/Loan Application for Nursing Students enrolled in the Junior/Senior year or equivalent of the RN Program. In exchange for the scholarship, candidates make a commitment to work full time at St. John's for 12-24 months (determined by amount of scholarship) after graduation and licensure as a Registered Nurse.

Before applying, please review eligibility requirements:
1. You must submit documentation (e.g.acceptance letter) of your enrollment in an accreditied nursing program.
2. For students planning to graduate after spring semester, the application must be received by April 1 of your junior year to be considered for both years of the scholarship. For students planning to graduate after the fall semester, the application deadline is November 1.
3. You must submit two (2) letters of recommendation (from nursing faculty) with your application. Reference forms will be sent to you via e-mail when an application is recieved.
4. You must submit an official transcript of your grades at the time of application. A cumulative GPA of 3.0 is required.

For questions regarding eligibility and participation in the scholarship program, contact the Nurse Recruiter at 1-866-601-4744 or 1-217-757-6837.

APPLICANT INFORMATION

Fill out all required (*) fields

* Name

* Permanent Street Address

* City

State

* Zip Code

(5-Digit)

* Telephone

(999-999-9999)

* E-Mail Address

* Nursing Program Graduation Date

(MM/DD/YYYY)

* College Attending

Please Read Carefully And Sign.

Fill out all required (*) fields

I agree to work for St. John's Hospital, Springfield, Illinois full time commencing upon completion of academic preparation and licensure requirements. I further agree to enter into a Scholarship/Loan Repayment Agreement with St. John's Hospital regarding my repayment obligations should I not be able to complete the employment commitment for any reason whatsoever. I further give ST. JOHN'S HOSPITAL the right to contact the Financial Aid officer/designee at applicable educational institution to make a determination of how much aid I am currently receiving and/or will receive during my educational career at the educational institution. I further attest that all statements on this application are true.

* Signature

(Type your name in field)

Date

3/16/2010