Moundview Foundation Scholarship form | Gundersen Health System

Basic information

Your name

Email

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Education

High school name

High school graduation date

Enter your graduation date, past or anticipated.

High school GPA

Post-secondary institutions

What post-secondary institution(s) have you been accepted into or are currently attending?

What healthcare field or major are you considering or currently pursuing?

Estimated program length?

Post-secondary GPA (If applicable)

Post-secondary graduation date

Enter your graduation date, past or anticipated.

Extracurriculars

Describe any community/extracurricular work or activities you have done (organizations that you belong to, service work, community projects, sports, leadership roles, etc.)

Academic honors

Describe any special recognition you have received for excellence in school work (honors, prizes, etc.)

Transcript

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Please attach your most current transcript (high school graduation, college graduation, or in-progress college) for review.

Employment

Are you currently employed?

Yes

No

Current employer

Current position

Employer

Employer phone number

Previous employers

Previous employer 1

Position

Employer

Employer phone number

Previous employer 2

Position

Employer

Employer phone number

Previous employer 3

Position

Employer

Employer phone number

Additional information

Essay

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.

References

List the names of three character references. Please do not include relatives. Each must submit a short letter of reference.

Reference Letter

Maximum 3 files.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Please attach a letter from each reference listed.

Comments

Terms of application

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