JOHNSON MEMORIAL HOSPITAL
$1,500 MEDICAL STAFF SCHOLARSHIP

HIGH SCHOOL STUDENT APPLICATION 

S T U D E N T    I N F O R M A T I O N 	
Student Name:
  	Current School attending:	
Address:  
	College/University to attend:	
City/State:  	Expected Major: 
	
Home Phone #:	Cumulative Average (100 pt. scale): 
	
Cell Phone #:	Email:	

Number of siblings & any family members currently attending college (list names and ages):  

Complete the section below ONLY if you are a
 ‘Student Volunteer’ or the ‘Child of a JMH Employee’	
Father’s Name if a JMH Employee:  	Occupation/ Subsidiary or Dept. of employment & years of service: 
	
Mother’s Name if a JMH Employee:	Occupation/ Subsidiary or Dept. of employment & years of service: 
	
Student Volunteer Location (Subsidiary or Department).  Please list # of hours acquired and last date of service:
	
C R I T E R I A    F O R    S E L E C T I O N 	

1. High School Graduate in 2025
2. Enrollment in an accredited 
2 or 4-Year College/Program connected to Healthcare or Human Services
	
3. Academic success
4. Required attachments listed below	
5. Special attributes, extenuating circumstances or community service history that supports why this student should be selected	
R E Q U I R E D   A T T A C H M E N T S 	

•	Sealed Transcript provided by the Guidance Department 
•	Personal Statement (not to exceed one page)
•	Letter of Recommendation from a non-relative 
	
APPLICATION DEADLINE:  April 1, 2025	

Application must be returned to:	Medical Staff Scholarship Program
c/o The Medical Staff Office
Johnson Memorial Hospital
201 Chestnut Hill Road
Stafford Springs, CT  06076

Or via email to: teresa.rogers@trinityhealthofne.org