Application

"*" indicates required fields

Step 1 of 6

16%

Facility*

How long have you been working for HMG?*

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Address

Home Address*

Street Address City State ZIP Code

Education

Are you currently enrolled in school?*

Yes

Academic Interest*

Are you full time?*

Yes

Level of completed education*

Name of Certificate*

Name of High School*

Name of College or University*

Subject*

Date*

MM slash DD slash YYYY

Extra-Curricular Activities*

Community Service Involvement

Endorsements

First Endorsement

Name*

Administrator*

Phone*

Company/Relationship*

Second Endorsement

Name

Director of Nursing*

Phone

Company/Relationship

Third Endorsement

Name

Title

Phone

Company/Relationship

Fourth Endorsement

Name

Title

Phone

Company/Relationship

Applicant Essay (no more than one page)

To help us evaluate your scholarship application, please tell us about yourself. Include any details you believe will aid the committee in making their decision.

Tell us in detail about yourself and your:

family
job
community involvement
volunteer work
aspirations and goals in life

Essay*

Why should the HMGU Scholarship Committee select you as a scholarship recipient?*

Free form writing – no more than one paragraph.

Candidates for these scholarships are selected based on:

Full-time Employee of HMG Healthcare
Workplace achievements
Character and leadership ability
Breadth and depth of community service

The scholarship committee of HMGU has been entrusted with the task of deciding which candidates will be awarded a scholarship.

The information reported is true, correct, and complete*

Yes

If selected for HMGU Scholarship, I will comply with program requirements as stated below.*

Yes

Employee Obligation. Education Performance: The employee commits to exerting reasonable effort to complete the educational program to the best of their ability. If the employee fails to complete, withdraws from, or is expelled from the program, or fails to meet the academic standards required, the employer reserves the right to place the employee on academic probation or terminate the scholarship support. Work Performance: The employee agrees to maintain full-time employment status and fulfill all job-related responsibilities, including attending required meetings and completing assignments as part of their normal duties. Should the employee's working hours fall below 40 hours per week, or their job performance is deemed unsatisfactory, the scholarship may be subject to probation or cancellation.

Applicant Signature*

Date*

MM slash DD slash YYYY

Incomplete applications will result in the elimination from HMGU Scholarship process.