top of page
This site was designed with the
.com
website builder. Create your website today.
Start Now
Log In
Scholarship Application
Applicant Information
First Name
Last Name
Are you a current LPN member?
Choose an option
Address (include city & zip)
Email
Phone
Education
College Attended
Did you graduate?
Choose an option
Degree
College Attended
Did you graduate?
Choose an option
Degree
High School Attended
Did you graduate?
Choose an option
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!
bottom of page
