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Glendive Medical Center

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