Providence Scholars Program Application Template

Applicants should plan to complete the application in one sitting. The option to save and return to the application is not available. We suggest that applicants draft their responses using the template provided below.

Questions concerning application completion and technical issues with the electronic application may be directed to Patricia Patyrak at patyrak@up.edu. Automatic notifications are sent upon application submission to references and to applicants when references fill out the reference form. Please ensure that applicants and references list the following email a safe sender: noreply@qemailserver.com. Some servers think this message is junk. 

Contact Information

* Represents a required field
 First Name*
 Middle Initial
 Last Name*
Address*
 City*
 State*
 Zip code*
 Primary phone number*
 Secondary phone number
 Primary email address*
 Secondary email address 

Academics

A minimum cumulative 3.25 GPA and a cumulative 3.25 science GPA is required to apply. The University will calculate your cumulative GPA from official transcript(s) and will calculate your GPA in completed science courses from Anatomy, Physiology, General Biology, and Microbiology grades.

If you have earned a bachelor's or master's degree, please provide the information about the degree or degrees here:

Bachelor's Degree Major

Bachelor's Degree Year Graduated

Bachelor's Degree Name of University

Master's Degree Major

Master's Degree Year Graduated

Master's Degree Name of University

Leadership Experience

If you have leadership experience, since high school or within the last five years, list below. Leadership is defined as an officer of a formal group, club, or organization and should include concrete examples of use of leadership skills. Other examples of how you have exhibited leadership skills are allowed, even when outside a formal leader role.

Please include dates, titles or roles, and briefly describe responsibilities and/or examples of when you displayed leadership skills.

Dates, Title or Role, Responsibilities and/or examples of leadership skills

Management Experience

List any management experience. Management is defined as direct responsibility for the supervision of employees, e.g., hiring, firing, performance evaluations (Examples of positions that are not considered management are: event coordination, office management without direct reports, camp coordinator, etc.).

Provide dates of employment, title, employer, number of employees you managed and your supervisory duties.

Dates, Title, Employer, # of employees, Supervisory, Duties

Community Service

Provide dates (month/year) and briefly describe activities and dates of volunteer experience within the last five years (Maximum: five experiences).

Dates (month/year), Service Agency, Activity, Approximate Hours of Service

Providence Community Service

Of the hours listed above, how many of those hours were done with Providence Health & Services.

Work Experience in a Health Care Setting (do not include volunteer experience)

Do you have direct patient care work experience in a clinical setting? If yes, select one of the following roles in the drop down menu.

List all of your direct patient care work experience below and indicate which experience/s correspond with your selection from the drop down menu (LPN, CNA, PTA, LSW, CMA, Other).

Dates of employment (month/year), Employment Position, Employer

Do you have non-clinical work experience in a health care setting? Examples: Information Technology, Finance, Housekeeping.

If yes, list your employment information below:

Dates of employment (month/year), Employment Position, Employer

Relative is a PH&S Employee

If you have a first degree relative who is a PH&S employee, provide the relationship to you (parent, child, sibling, spouse):

Provide employment information of relative working at Providence:

Dates of employment (month/year), Name of Relative, Facility/Department

Current Status of Applicant

I am authorized to work in the United States during my three-year post-graduation commitment at Providence (Yes/No)

Please select the category that best describes your status with the University of Portland (Transfer student applying for admission, UP nursing student, UP student applying from another major)

References

Three references are required for the Providence Scholars Program application. Enter reference information in the fields provided below. It is imperative that the email addresses provided are accurate and current. Upon submission of your application, your references will receive an email with a link to provide their reference information. You will receive an email confirmation when each reference is received by the School of Nursing & Health Innovations. Please ensure that applicants and references list the following email a safe sender: noreply@qemailserver.com. Some servers think this message is junk. Safe sender instructions.

References must be submitted by mid-February for continuing students and early May (exact dates will be communicated in the electronic application form) for transfer students. It is your responsibility to ensure that your references have been submitted by the deadline.

1. Employer/Supervisor Reference (Name, title, facility, email address, optional-phone number)

2. Professor/Instructor Reference (Name, title, school, email address, optional-phone number)

3. Personal Reference - Non-Family/Non-Employer/Non-Faculty ((Name,affiliation, email address, optional-phone number)

Essay

In the space provided, please write an essay (500-word maximum) based on the mission statement and core values of Providence Health & Services. Specifically describe how you will incorporate the mission and core values into your work as a potential Providence employee or as a nursing student at the University of Portland.

Note: If copying content from Word, first copy and paste it to a basic text editor program (PC-Notepad; Mac- TextEdit) to ensure the best compatibility with the Qualtrics application form.

Providence Health & Services Mission/Core Values

Mission: As expressions of God's healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

Core Values: Compassion, Dignity, Justice, Excellence, Integrity

To view the complete Core Values, visit the Providence Health & Services Mission & Values page.

Do you speak any language other than English? Specifically, would you be able to conduct a conversation in this language? If yes, explain here (max 100 words):

Do you have an advanced experience of any other than the mainstream American culture? If yes, explain here (max 100 words):

Additional Considerations

Is there anything you think we should consider that is not captured in the previous questions (max 100 words)?

Application Submission

Submit this application by mid-January for continuing students beginning the junior year the following Fall semester or by early April for transfer students applying for Summer entry in the following year to be considered for the Providence Scholars Program.

Applicant Signature

Your Providence Scholars Program application and reference forms will become part of your Providence employee file if accepted as a Providence Scholar. Should you be accepted to the Providence Scholars Program, your progress and satisfactory performance throughout the University of Portland School of Nursing & Health Innovations program will be closely monitored and reviewed. Continuation of the award will be contingent on consistent fulfillment of the School of Nursing & Health Innovations' academic and professional standards.

 (check box) I certify that the information set forth in this application is true and complete to the best of my knowledge.