Nursing Educational Award Questionnaire

First Name

Last Name

College of Nursing Program

Degree

Nursing Program Start Date

Anticipated Graduation Date

1. How did you hear about the UK HealthCare Nursing Educational Award Program?

(Please limit text to no more than three lines.)

2. Are you currently receiving an educational award or scholarship from another facility?

Yes

3. Do you plan to work while attending school?

Yes

If yes, where and how many hours per week?

Please list in the space below the dates and times you are available for an interview during the application deadline month. If your application is accepted, a Nurse Recruitment office representative will contact you by phone or email with your scheduled interview date and time.

Please note that we cannot reschedule appointments. (Please limit text to no more than three lines.)

Please answer the following questions in narrative form. (Limit text to no more than six lines for each answer.)

1. Describe your greatest accomplishment since high school or starting college.

2. Why have you chosen a career in the nursing profession?

3. What do you foresee as your future obligation and/or contribution to the nursing profession at UK HealthCare?

4. What short-term goals have you set for yourself? What do you envision yourself doing five years from now?

5. What three special characteristics do you possess that make you deserving of this award?

I've read and agreed to these terms.

Signature

Date

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Appointment

Doctor

MyChart

Nursing Educational Award Questionnaire