Award Nomination Forms

The Tarutis/Repetti Scholarship Fund

Candidate:
Name:
Home Address:
City, State, Zip:
Phone:

Career Information:
Currently employed at:
Current Position:
Date of Employment:

How long have you been working in long-term care (include positions and titles)?
List information concerning your education.
Prior schooling (name of school, city/state, grades completed, courses, etc.)
Present/Future enrollments (name of school, city/state, courses, degrees, etc.) Fax proof of enrollment or letter of acceptance to 410-792-4617. Include courses to be taken.
Semester Dates:
In 70 words or less answer the following questions. a. Why did you choose a career in long-term care? b. How have you personally and professionally benefited from your experience in long-term care? c. What unique challenges does long-term care hold for you? d. What are your future career goals and how do you plan to accomplish them?

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