Current Title/Position: *

Phone: *

Email: *

Facility Name: *

Where you or your immediately family member currently works.

When do you anticipate completion of the of the RN/LPN program? *

List any hobbies, interests, and community involvement: *

List any achievements, awards, or special recognitions: *

Please write a short narrative on why you chose a career in long term care and what makes you an excellent candidate for a George F. MacKenzie Scholarship. *

Letters of Reference: *

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 16 MB, Max. files: 4.

Please attach at least two letters of reference. One letter should be from an educator or a past employer who has known you for at least one year. Neither reference may be from a relative.