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Scholarship Application
Applicant Information
First Name
Last Name
Are you a current LPN member?
Choose an option
Yes
No
Considering it
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Address (include city & zip)
Email
Phone
Education
College Attended
Did you graduate?
Choose an option
Yes
No
Still attending
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Degree
College Attended
Did you graduate?
Choose an option
Yes
No
Still attending
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Degree
High School Attended
Did you graduate?
Choose an option
Yes
No
Still attending
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Personal References
Please list three professional references
Reference 1
Full Name
Relationship
Company
Phone
Address (include city & state)
Reference 2
Full Name
Relationship
Company
Phone
Address (include city & state)
Reference 3
Full Name
Relationship
Company
Phone
Address (include city & state)
Employment History
Company Name
Job Title
Address (include city & state)
Company Phone
From
To
Responsibilities
Company Name
Job Title
Address (include city & state)
Company Phone
From
To
Responsibilities
Company Name
Job Title
Address (include city & state)
Company Phone
From
To
Responsibilities
Scholarship Program Information
Name of Program
Cost of Program
Program Purpose
Provide a brief essay explaining how this program will benefit you and the Latina community at-large.
Walk us through a personal hardship significant to your story and how you overcame it.
I certify my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Your Signature
Clear
Submit
Thank you for submission!
