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Name required.
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Current GPA required.
Enter Current GPA as 4.0.
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Name of high school or program you are attending required.
Anticipated Year of Graduation required.
Enter Anticipated Year of Graduation as YYYY.
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Please enter the date as MM/DD/YYYY.
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Planned Health Career required.
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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 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) Obstacles you have overcome and how
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 (Personal Info Form)
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 call (209) 800-7170.