Application form

Healthcare Scholarship

This is a scholarship application for one of the $500 Healthcare Scholarships from the Foundation for Thayer County Health Services or the TCHS Hospital Guild.

Personal Information

Your Name(Required)
Your Email Address(Required)
Address

Education History

What High School did you graduate from or will graduate from?
Year you did or will graduate High School
Have you previously taken an college or technical school?(Required)
Have you previously earned a degree ?(Required)
If you have already earned a degree, please list what it is in.
List any other certifications or education you have received.
Are you enrolled at this time?

Work History

Your Previous Employers
Please list your previous employers, the dates you worked and the position you held
Employer
Dates
Position
Phone
 

Experience and Interests

List any experience you have received in a healthcare field. (i.e. a job shadow)
Healthcare field of study you are interested in.(Required)
Are you interested in working in a rural hospital/clinic?(Required)
Would you be interested in working for Thayer County Health Services after you have completed you education?(Required)
List up to five activities or organizations you are actiive in.
1st
2nd
3rd
4th
5th
 
List up to five volunteer activities you are involved in.
1st
2nd
3rd
4th
5th
 

More About You

Upload can be in a .pdf, .doc or .docx format
Drop files here or
Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
    Answer if Transcripts are not being uploaded.
    Upload two or more letter of recommendation. If the letters are not signed, they will not be accepted. Letters may be uploaded in .pdf, .doc or .docx format
    Drop files here or
    Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
      Answer if Letters of Recommendations are not attached.
      Only signed Letters of Recommendations will be accepted. No letters will be accepted after April 1st.