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Moundview Foundation Scholarship form

Basic information



Enter your graduation date, past or anticipated.
What post-secondary institution(s) have you been accepted into or are currently attending?
Enter your graduation date, past or anticipated.
Describe any community/extracurricular work or activities you have done (organizations that you belong to, service work, community projects, sports, leadership roles, etc.)
Describe any special recognition you have received for excellence in school work (honors, prizes, etc.)


Are you currently employed?

Current employer

Previous employers

Previous employer 1

Previous employer 2

Previous employer 3

Additional information

In 2-3 sentences each, please describe 1) Your healthcare goals 2) Why you have chosen a healthcare career 3) Why you should be considered for a scholarship.
 List the names of three character references.  Please do not include relatives. Each must submit a short letter of reference.
Required documents

As a part of this application, you are required to provide your transcript and up to three letters of recommendation from your references. Please email these documents to Tammy Lowrey before or shortly after submitting your application.

By typing your name, you are electronically signing this form.

1900 South Ave.
La Crosse, WI 54601

(608) 782-7300

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