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Merlin Brondum Memorial Scholarship

Online Application Form

PROVIDE A COPY OF THE LETTER OF ACCEPTANCE INTO THE ALLIED HEALTH PROGRAM.



* represents a required field
* First Name
* Last Name
* Address 1
  Address 2
* City
* State
* Zip Code
* Daytime Phone
* E-mail Address
* High School Attended
* Year Graduated
* County in which you reside
(Limited to: Burt, Cuming, Dakota, Dixon, Thurston and Wayne counties)
* College Attending
ACADEMIC PERFORMANCE & HEALTHCARE EXPERIENCE:
* College grade point average
  College transcript and copy of acceptance letter or notification of acceptance must be submitted
If not submitted, please give explanation.

Submit copies to:
Merlin Brondum Memorial Scholarship
Attn: Kelly Kaup
PO Box 100
Pender, NE 68047
* Healthcare Experience
* My career objective in three hundred words or less. Please relate your career objectives to the health needs of people living in rural areas.
* College and community activities. (List activities, service clubs, work experience, etc.).
FINANCIAL NEED:
Cost of program for one year.
  Tuition
  Books
  Room/Board
  Travel
  Other
  TOTAL
RESOURCES AVAILABLE:
  Other Scholarships
  Pell Grant
  Employment
  Loans
  Family Assistance
  Reserves
  Other
  TOTAL