Events
- Estate Planning Seminar
- Giving Tuesday
Donor Impact
Giving Opportunities
Contact Us
Midland Memorial Foundation
Permian Basin Behavioral Health Center
Foundation Sholarship Programs
- Midland College Scholarship Program
- Midland Health Employee Scholarship

How can we help you? (432) 221-1569

Home

Midland Memorial Foundation

Our History

Governing Board and Leadership

Philanthropy Team

Quarterly Newsletters

Giving Opportunities

Donation

Named Endowment Funds

Spotlighted Funds

Planned Giving

Donor Impact

Faces Of Philanthropy

Annual Endowment Gift

Donor Recognition

Scholarship Programs

Midland Health Employee Scholarship

Midland College Scholarship Program

Events

Estate Planning Seminar

Giving Tuesday

PBBHC

Midland Health Scholarship Application Form Page

* Denotes required field

*Applicants must be accepted into the program prior to applying for scholarship.

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Email *

Phone Number *

Are you legally authorized to work in the United States? *

Yes

Do you now, or will you in the future, require sponsorship for an employment visa status to work legally in the United States?* *

Yes

Have you completed the FERPA agreement, allowing Midland College to share my academic record with Midland Health Human Resources Department? *
If, no, please visit https://www.midland.edu/about/media/documents/ferpa-waiver.pdf, and complete form.

Yes

Which program are you seeking scholarship assistance? *

Certified Nurse Aide (CNA)

Licensed Vocational Nurse (LVN)

LVN to RN Transition Program

Associate Degree (RN)

Pharmacy Technician

Phlebotomy

Radiologic Technologist

Respiratory Care

Sonography

Have you received your letter of acceptance for the program? *

Yes

What is your estimated start and end date?

Start date: *

End Date: *

Please submit your acceptance letter with this application *

Do you now, or have you ever been employed by Midland Memorial Hospital? *

Yes

Dates of employment

Start Date *

End Date *

Department *

Manager Name *

Certification

To the best of my knowledge, the information provided on this application is correct and complete. I agree that Midland College and Midland Health have my permission to verify any and all information. I understand that applying for the Midland Health Scholarship Program affirms my wish to be considered but does not guarantee selection into the Midland Health Scholarship Program or an award of a Midland College scholarship. If accepted into the Midland Health Scholarship Program, I understand that my academic record will be shared with the Midland Health Human Resource Department per semester and upon my certification or degree completion.

Print Name *

Signature *

Captcha *

You are unable to proceed with the application process at this time. Please reach out to your Midland College Admissions Department for further information. You are encouraged to resubmit your application once you have received your letter of acceptance into the program.