JOHNSON MEMORIAL HOSPITAL
$1,500 MEDICAL STAFF SCHOLARSHIP

HIGHER EDUCATION STUDENT APPLICATION 

S T U D E N T    I N F O R M A T I O N 	
Student Name:
  	Phone#:	
Address:  
	Email:
	
City/State/Zip:	College/University to attend:
	
GPA:
	Major or Academic Program:
	
   JMH Employee
   Adult Volunteer
   Prior Recipient	

*Please indicate your relationship by marking one of the boxes to the left	
Complete the section below ONLY if you are a
‘JMH Employee’ or an ‘Adult Volunteer’	
Occupation/ Subsidiary or Department where employment or volunteer service is rendered:

Years of Service (if you are an Employee):

Hours of Service (if you are an Adult Volunteer):

Notes:

C R I T E R I A    F O R    S E L E C T I O N 	

1. Enrollment in an accredited 
2 or 4-Year College/Program connected to Healthcare or Human Services
	
2. Academic success
3. Required attachments listed below	
4. 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 
•	Personal Statement (not to exceed one page)
•	Letter of Recommendation from a non-relative 
	
APPLICATION DEADLINE:  April 1, 2025	

Applications 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