Glendive Medical Center : GMC Foundation Scholarship Application

GMC Foundation Scholarship Application
The Glendive Medical Center Foundation provides recognition and financial support to students interested in pursuing a career in healthcare and accounting/business. These Foundation Scholarships are awarded annually to individuals who exhibit a strong desire and the potential to excel in their field. Scholarship recipients will be asked to submit a photo suitable for printing, and a formal thank you letter.
An independent selection committee, administered by the GMC Foundation Board of Directors, will select the scholarship recipients.
	Part I - Personal Information
*	Full Name First, MI, Last
*	Street Address 1
	Street Address 2
*	City
*	State WA, OR, ID, etc.
*	Zipcode
	College Address
*	Home Phone Number xxx-xxx-xxxx
	Work Phone Number xxx-xxx-xxxx
	Cell Phone Number xxx-xxx-xxxx
	E-mail Address
	High School Graduated From
	Year
	Part II - Program Information
	This application is for the academic year beginning
	Name and address of college or university to be attended
	Program of study is
	What year of study are you starting?	Undergraduate First Undergraduate Second Undergraduate Third Undergraduate Fourth Graduate First Graduate Second Graduate Third Doctorate First Doctorate Second Doctorate Third Doctorate Fourth Other
	Are you currently working?
	# of hours per week
	Do you plan to continue working?
	# of hours per week
	Extra-curricular or community volunteer activities
	Honors received, achievements, recognition
	How will your college education be financed?
	Anticipated annual costs	$
	Have you ever been convicted of a felony?
	Are you a United States citizen?
	Essay Please include a 250-word maximum essay on "how I chose my major and what I will contribute to my chosen profession upon graduation."
*	Please sign (electronically) and date: I certify that the information provided is complete and accurate to the best of my knowledge.	I Agree I Do Not Agree
*	Today's Date mm/dd/ccyy