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Scholarship Application

Please share who or what influenced you to aspire to a career in the healing arts. (Add pages as needed)

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Please highlight those experiences that have encouraged you to pursue a degree in a medical field. Include any work, classes or job shadowing experience. (Add pages as needed)

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Include your educational plan as you write about the career or life work you want to pursue. (Add pages as needed)

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Three (3) Letters of Recommendation are required. References may be personal or professional.

(Letters of recommendation must be sealed in their own envelopes and signed by the recommender across the seal.)

1. Name: ______________________________ Day Phone:________________ Other Phone: _______________

Mailing Address: _______________________ City: _____________ State: __________ Zip Code: _________

Occupation:_______________________________

2. Name: ______________________________ Day Phone:________________ Other Phone: _______________

Mailing Address: _______________________ City: _____________ State: __________ Zip Code: _________

Occupation:_______________________________

3. Name: ______________________________ Day Phone:________________ Other Phone: _______________

Mailing Address: _______________________ City: _____________ State: __________ Zip Code: _________

Occupation:_______________________________

Please attach a recent photo.

NOTE: The deadline of March 15th includes having three letters of recommendation; ACT and/or SAT scores; transcripts and completed application sent to the address listed above.    No incomplete applications will be considered.

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