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Scholarship Application

Name:_____________________________________________________________

          Last                                                   First                                M.I.

Address:___________________________________________________________

Town                                                          State                     Zip

Phone number_______________________________________________________

Social Security Number:_______________________________________________

Name and address of high school:_______________________________________

Year of graduation from high school:_____________________________________

Please attach:             ~ a transcript

~ an activity sheet

~ two letters of reference

~ and a one page essay about why you want to work in the healthcare field

   and what makes you a good candidate.  Include any qualifications you

   might think are relevant. 

Application with attachments must be received at Athol Memorial Hospital, 2033 Main Street, Athol, Massachusetts  01331 no later than April 1^st.

For more information please call:

Athol Memorial Hospital Community Relations at 978 249-1143

Award and acknowledgement letters will be mailed to applicants by April 30th.  Recipients must be willing to be photographed for publicity purposes.  Funds will be disbursed by Athol Memorial Hospital at the completion of the first semester/term, upon proof of good standing, and a minimum completion of eight (8) credits or the equivalent.