Hackensack Meridian Health

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HACKENSACK MERIDIAN HEALTH MILDRED H. ROSA TRUST

PRESIDENT'S SCHOLARSHIP AWARD APPLICATION 2019

ALLIED HEALTH

Meridian Health Campus: ___JSUMC ___OMC ___RMC ____SOMC ____BCH _____RBMC (Perth Amboy) _____RBMC (Old Bridge) ____Corporate ____ MH Affiliate: Site and Location__________________________________________

INSTRUCTIONS: The Mildred H. Rosa Trust President's Award Scholarship acknowledges outstanding service and commitment to the mission, vision and values of the Legacy Meridian Health Hospitals. Candidates for this award must be enrolled in a college program in an allied health discipline. Applicants must provide documentation on specific contributions that they have made to an environment of excellence at a Legacy Meridian Health campus.

DEADLINE: April 2, 2019

Program Type:_____________________________________________________________

Name ____________________________________Employee ID_________________________ Address_______________________________________________________________________ City___________________________________State_______________Zip Code____________ Telephone: Home_______________Work________________Cell___________________ Email________________________________Position_____________________________ Unit_________________________Nurse Manager_______________________________ Marital Status_______No. of Dependents________ Peoplesoft ID__________________ Years of Service at Hackensack Meridian Health __________ ____Full Time____Part Time_____Per Diem (Number of days per month at MHH_______) Eligible for Tuition Reimbursement: ____Full ___Partial ___Not eligible Name of School___________________________________________________________ Current Program of Study______________________________________________________ Date of Entry ______________Expected Date of Graduation Month/Year_____________ GPA for prior semester based on 4.0_____________ Cumulative GPA__________________ Number of credits this semester_______ Total credits earned to date_________ Course Title(s) this Semester_____________________________________________________ ______________________________________________________________________________ Membership in Professional Associations/Offices Held________________________________ ______________________________________________________________________________ Membership in Hospital Committees_______________________________________________ Awards_______________________________________________________________________ Certifications_____________________________________________________________

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Community Service____________________________________________________________

II. Your application will not be considered without all of the following documentation: Place a check next to the enclosed documents.

___1. Signed, dated complete application ___2. Signed, dated Personal statement ___3. Signed, dated Manager support letter ___4. Signed, dated Peer support letter ___5. Resume/CV

___6. Program Cost documentation (bills, receipts or catalog fee schedule)

___7. Proof of acceptance into allied health program (or proof of current course

registration)

III. Personal Statement: Include in your personal statement how you have contributed to an environment of excellence at Legacy Meridian Health campus and how you exemplify the mission, vision, and values of the organization. Your statement should relate to one or more of the five pillars of excellence: People, Service, Quality, Finance, Growth, or address specific behavioral standards. Limit your response to no more than two pages. Back up your personal statement with documentation of your accomplishments (letters from patients, peers, manager, awards received, performance improvement projects that you have participated in, publications or presentations etc.)

Please sign and date your statement.

I attest that the information contained in this application is correct. I agree to accept all decisions for scholarships made by the Selection Committee. If I receive and accept a scholarship, I agree to work for Hackensack Meridian Health for at least one year.

____________________________________ Signature of Applicant

_____________________________ Date

All information provided in this application will be kept confidential. Please make sure that the application is complete and includes all additional documentation required as well as your personal statement.

Send to:

Hackensack Meridian Health Ann May Center for Nursing and Allied Health Attn: Teri Wurmser, Ph.D., RN 1350 Campus Parkway, Suite 101 Neptune, NJ 07753

Or FAX:

732.481.8597

Or EMAIL:

AnnMayCenter@

For more information call The Ann May Center for Nursing at 732.481.8570/8578

PLEASE DO NOT USE STAPLES

PLEASE KEEP A COPY OF YOUR APPLICATION FOR YOUR RECORDS.

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