Applications must be submitted by Friday, March 25, 2022

Please complete PARTS I, II, III and IV of the application.

Applications with missing or incomplete information will not be considered.

Check all that apply:

    Applicant must be an ancillary staff member (i.e., laboratory, radiology, or pharmacy technician, physical or occupational therapist, care coordinator or social worker, dietary/food nutrition, environmental service, medical records/HIMS, billing, coding, security, business associate) who has worked at NCMC at least 90 days and seeking continuing education or certification to advance their career within their field. This is a one-time scholarship up to $900 and is not renewable. Applicant must be an employee of NCMC for at least 90 days.

    PART I



    Please answer all questions completely. If a question does not apply to you, answer with either N/A or 0.


    Date of Birth:

    Month: Day: Year:

    What is the cost of the course, certification, or seminar? $

    What is your spouse's occupation?
    What is your spouse's monthly gross income? $

    If so, how many?


    PART II


    Essay
    (Please attach a Word document that includes answers to both questions)

    • Explain why you are applying, how this scholarship will help your professional development and/or advance your career within your field?
    • What would it mean to you to win this scholarship award?


    PART III


    Resume/References
    (Please attach Word documents or pdfs here)

    • A current resume indicating your academic history, employment history, achievements, and awards.
    • Please provide a letter of reference from your department head.