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.
* Represents a required field
First Name*
Middle Initial
Last Name*
Address*
City*
State*
Zip code*
Phone number*
Email address*
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 (UP nursing student (nursing major), UP student transferring from another major, Student transferring from another college/university)
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 already 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
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
List any organizational management experience. Organizational management may be defined as direct responsibility for the supervision of employees or volunteers, and also event coordination, office management, etc.).
Provide dates of employment, title, employer, number of employees you managed and your supervisory duties.
Dates, Title, Employer, # of employees/volunteers, Supervisory, Duties
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.
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
If you have a first degree relative (spouse, child, parent, sibling) who is a PH&S employee, provide the relationship to you:
Provide employment information of relative currently working at Providence:
Dates of employment (month/year), Name of Relative, Facility/Department
Enter reference information in the fields provided below. It is imperative that the contact information provided is accurate and current. Upon submission of your application, your references may be contacted at our discretion to fill out a reference form.
References must be submitted at the time of application submission. It is your responsibility to inform your references that they may be contacted.
Employer/Supervisor Reference (Name, title, facility, email address, optional-phone number)
Professor/Instructor Reference (Name, title, school, email address, optional-phone number)
Personal Reference - Non-Family/Non-Employer/Non-Faculty ((Name,affiliation, email address, optional-phone number)
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):
Is there anything you think we should consider that is not captured in the previous questions (max 100 words)?
Application deadline is January 10, 2006 (continuing students and transfer students).
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.
University of Portland
5000 N. Willamette Blvd.,
Portland, Oregon 97203-5798
503.943.8000
