Foundation Scholarship

First name

Middle initial

Last name

Colleague ID

Address

City

State

Zip code

Phone number

Email

Marital status

Number of dependent children

Name of school you are attending/have been accepted to attend

Degree you are seeking

Number of semesters already completed

Current GPA

Mark all hospitals that you work within

HSHS St. Vincent Hospital - Green Bay HSHS St. Vincent Children's Hospital - Green Bay HSHS St. Mary's Hospital Medical Center - Green Bay HSHS St. Nicholas Hospital - Sheboygan HSHS St. Clare Memorial Hospital - Oconto Falls

Department(s) employed in

Position

Years of employment at HSHS

Employment status

Full time Part time

Director/Manager’s name

What is your total annual household income (Household income includes the gross income of each person, 15 years or older, living in the home.)

Have you received a scholarship through this program in the past?

Yes No

If Yes, please provide years received

“I am proud to work at HSHS because…”

“My career goals are…”

“I need financial assistance because…”

“My education will benefit patients by...”

List extracurricular or community activities, honors, and awards; offices held; etc.

Transcripts

Please select a file

I understanding that no funds will be released until my 'Thank You' letter is submitted

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Foundation Scholarship

Application Requirements

Contact for Questions

Scholarship Application