St. Mary's Minority Health Care Scholarship Program
Applicant Flow Data
Equal Employment Opportunity
St. Mary's Hospital Medical Center is an Affirmative Action/Equal Opportunity
Employer. As such, we invite you to provide the following information.
Completion of each item is voluntary and responses will be kept confidential.
This information for the scholarship program is used for recordkeeping
purposes. Refusing to provide the information will not result in adverse
treatment.
Name
Academic Major
Sex (Circle one) Male Female
Race (Circle one) African American
Hispanic
Asian American or Pacific Islander Native American
or Alaskan Native
Send to:
St. Mary's Hospital Medical Center
Personnel Department, 707 S. Mills Street
Madison, WI 53715
(608) 259-5566, 800-236-6101
Application Recommendation
Form Information Scholarship
List
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