Vandalia Health Southern Region Tuition Assistance Program Application

All fields are required. Please use none or zero where appropriate. You must be accepted and enrolled in an accredited school in order to be considered for this program. Anyone beginning their first semester must provide their acceptance letter on college letterhead in order to be considered. The application deadline date for spring semester is November 1, summer semester is April 1, and fall semester is July 1.

Which tuition assistance program are you applying?

Demographic information

First name

Middle initial

Last name

Street address

City

State

Zip

County of residence

Email address

Home / cell phone

Work phone

Are you a Vandalia Health CAMC employee

YesNo

Employee information

Employee ID

Hospital

Department

Job title (position)

Manager

Hire date

Education / School information

College enrolled

School street address

School city

School state

School zip

Student ID

Major

Semester enrolled in school

Is this your first semester?

YesNo

Please upload your acceptance letter. Letter must be on college letterhead and signed.

Please upload your most recent transcript

Degree type

AssociateBachelorOther

Other degree type

Anticipated graduation date

Have you completed FAFSA?

YesNo