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Name required.
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Name of high school or program you attended required.
Year Graduated required.
Enter Year Graduated as YYYY.
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Please enter the date as MM/DD/YYYY.
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Name of College You Currently Attend required.
Please Select Your Undergraduate Class required.
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Your Specific Health Career required.
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Please select the program you are on track to complete required.
Anticipated Year of College Graduation required.
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Most Recent Cumulative College GPA required.
Enter Most Recent Cumulative College GPA as 4.0.
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Email Address required.
Please enter a valid Email Addresss.
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Phone Number required.
Please enter a valid Phone Number, formatted as shown.
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Date of Birth required.
Enter Date of Birth as MM/DD/YYYY.
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Place of Birth required.
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Street Address required.
City required.
ZIP Code required.
Permanent Mailing Address (Home residence, P.O. Box, etc.)
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Current Home Address (if different from permanent mailing address)
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Estimated Annual Family Income required.
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Please select the Number of Siblings Attending College in 2019.
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Please answer each of the following questions using a maximum of 500 characters. For each section, describe your three (3) most recent activities.
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Please answer each of the following questions using a maximum of 500 characters.
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Personal Statement
Please answer the following question using a maximum three (3) pages, typed. Develop a personal statement telling the scholarship committee about:
1) Yourself
2) Your goals for the future
3) Your work experience
4) Your health-related community service experience
5) Honors or awards you have received
6) Who or what experience has been the greatest influence in your decision to pursue a career in the healthcare field
7) What you learned in your first year of college
8) Your current financial need
Please attach your personal statement to your application.
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Letters of Recommendation
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Required Attachments:
1. Official Transcripts
2. Recent Completed Personal Statements
3. Signed Photo Release (Photo Release Form)
4. Two (2) Current Letters of Recommendation (Guidelines For Recommendation Letter)
5. Recent Professional Photo
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Upload your documents here
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I certify that all of the information in this application is valid and accurate.
I further certify that I have read the Mentorship Information Sheet and consent to participate in the Mentorship Program, if I accept the Health Careers Scholarship.
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For more information about the Health Careers Scholarship Program, please contact scholarships@hpsj.com, or 209-461-2329.