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Contact Information
* First Name : 
* Last Name : 
* Phone : 
* Email Address : 
 
 
 
* Gender
 
Male
 
Female
 
Decline to specify
 
 
 
* Age
 
18-30
 
31-45
 
46-60
 
61+
 
Decline to specify
 
 
 
* Race
 
American Indian or Alaskan Native (not Hispanic or Latino; a person having origins in any of the original people of North America, and who maintains cultural identification through community recognition or tribal affiliation)
 
Asian (not Hispanic or Latino; a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Philippine Islands)
 
Black or African American (not Hispanic or Latino; a person having origin in any of the black racial groups of Africa)
 
Hispanic or Latino (a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race)
 
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino; a person having origins in any of the original peoples of the Hawaiian Islands, Guam, Samoa, Fiji, Tonga, or other Pacific Islands)
 
White (not Hispanic or Latino; a person having origins in any of the original peoples of Europe, North Africa or the Middle East)
 
Decline to specify
 
 
 
* Which of the following best describes your THR employment status?
 
I am not a THR employee
 
I am a THR Volunteer or Joint Venture employee
 
I am a THR employee
 
 
 
* What is the highest degree you have?
 
Bachelor's
 
Master's
 
None
 
 
 
* Which of the following best describes your tuition reimbursement status?
(Please read the choices carefully.)
 
Benefits ineligible employee with Bachelor's Degree
 
Benefits eligible employee with exhausted tuition reimbursement funds, and Bachelor's Degree
 
Benefits eligible employee with tuition reimbursement funds available, and Bachelor's Degree
 
Benefits eligible employee with exhausted tuition reimbursement funds (no degree)
 
Benefits eligible employee with tuition reimbursement funds available (no degree)
 
 
 
* What was your degree GPA?
   
 
 
 
* What was your Nursing Application GPA?
   
 
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