The Dixie Callahan Scholarship — St. Elizabeth's Alumni

Applicant Name(required)

First Name

Last Name

Street Address

City/Town/State

Zip Code

Phone (home)

Phone (cell)

Email(required)

For relatives of alumni please state full name, including maiden name, of alumnus and year of graduation

Alumnus Name

Graduation Yr

High school student entering nursing program or current nursing school student

School / program attending in the fall(Proof of acceptance or attendance is required)

Upload proof of acceptance or attendance(PDF, Word doc, or photo — max 4MB)

Upload transcripts of grades, including GPA(from high school, College or University — max 4MB)

Boston Medical Center - Brighton Employee or Volunteer

School / program enrolled in(Proof of acceptance or enrollment required)

Upload proof of acceptance or enrollment(PDF, Word doc, or photo — max 4MB)

Nursing Unit

Ext

Professional Growth and Development(Please list present degrees, certifications, specialty and preceptorship service)

Community Service(Please list community work: health and wellness, professional affiliations)

Kindness(Please describe a recent act of kindness)

Financial Assistance(Please describe your needs and other scholarships received)

Nurses applying: Quality Improvement(List all committees, in-services presented or lectures you have delivered to school groups)

Essay(No more than 250 words: why you are choosing to enter the field of nursing or why you are pursuing an advanced degree in nursing)