Holt serves as secretary of the NCC Student Nurses' Association. During her enrollment, she was the recipient of the Winnie Edwards Brown Nursing Scholarship established in 1996 to honor Mrs. Brown’s service as a nurse at Park View Hospital and as a teacher of Allied Health at Swift Creek Elementary School and Northern Nash High School. Holt also received the William S. Shrago Veteran Scholarship established in 2016 by William S. “Bill” Shrago, a veteran of the United States Air Force, to honor students who are veterans.

Holt was nominated for the DAISY Award by several clinical instructors. One nominator described a time when Holt was assigned to a non-compliant patient during a clinical day. According to this patient, Alexandra could not do anything right and did not know what she was doing. Despite working with a difficult patient, Holt maintained her professional demeanor, remaining calm and providing compassionate patient care.