Edwin W. Stedman

Scholarship Application 2016-2017

Sponsored by the Boston Chapter of the International Association for Healthcare Security and Safety

Personal Application:

Employment Status:

Permanent / Temporary / FullTime / Part Time

Please describe your duties:

Performance Evaluation:

The rating of your must recent evaluation was (check only one):

Excellent / Good / Fair / Needs Improvement

Identify any recognition/awards that you have received in your professional career:

Proposed Use of Scholarship Funds:

Is this a degree program?

Yes / No / Type:
Full Time / Part Time

Enrollment Status:

Anticipated Costs:

**double click on cells below to enter information, it should automatically calculate**

Are you a previous recipient of the Stedman Scholarship?

Yes / No / Date(s): / Total Amount Received: $

Applicant Essay–Pleasedescribe in the space provided below your reasoning for applying for this scholarship. Describe your educational objectives, future and career interests. Please include the steps that you have taken to enhance your personal skills and carry out a better job in the healthcare security or safety field.Please add another page if necessary.

Applicant Signature:Date:

Edwin W. Stedman Scholarship

Employer Verification/Recommendation 2016-2017

Sponsored by the Boston Chapter of the International Association for Healthcare Security and Safety

**this must be filled out by applicant’s supervisor**

Applicant Information:

Employer / Supervisor’s Information

Applicant’s Employment Status:

Permanent / Temporary / FullTime / Part Time / Other:

As the applicant’s direct supervisor, please provide an assessment of the applicant’s performance, work history, dependability, personal characteristics, attitude and strength. Please add another page if necessary.

Edwin W. Stedman Scholarship

Personal Recommendation 2016-2017

Sponsored by the Boston Chapter of the International Association for Healthcare Security and Safety

Please submit up to three personal recommendations.

Applicant Information:

Person Submitting Recommendation:

Please explain how this applicant’s personal characteristics, attitude and strengths make him/her a good candidate for this scholarship.

Edwin W. Stedman Scholarship

Professional Recommendation2016-2017

Sponsored by the Boston Chapter of the International Association for Healthcare Security and Safety

This recommendation could come from someone other than the applicant’s direct supervisorwho can attest to the applicant’s professionalism, competence and work ethic.

Please submit one professional recommendation.

Applicant Information:

Person Submitting Recommendation:

Please recommend how this applicant has demonstrated his/her potential in a work setting. Please include and assessment of the applicant’s business successes, professional skills, special qualities and strengths.

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