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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 2026.
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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 (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.