PSA Scholarship Application Form

Scholarship Application Form

Application Deadline - May 30, 2021
All winners will be notified on or before the 30th of April 2021.
Read and Understand the instructions below.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Full Name

First NameLast Name
Birthdate:

MonthDayYear
Mobile No. :

Area CodePhone Number
E-mail :
Where the confirmation will be send to
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you a US citizen?
Status at the time of application:
Are you a first generation college student ?
Major Area of Study:
Please indicate what is your major are of study
What is your Career Objective:

0/300
Are you interested in one of the following Scholarships?
Fall 2021 Scholarship of $300:
Have you submitted an application for admission?
II. High School Information:
Are you or will you be a June 2021 high school graduate?
June 2021 high school graduates are eligible for consideration for fall scholarships. Accepting a fall award obligates you to attend in the following fall and spring.
High School Attended:
Year of High School Graduation or GED:
Most recent cumulative GPA:
High School activities, community activities, volunteer work, honors, offices held:
IV. For Transfer Students Only:
Most recent college attended and cumulative transfer GPA:
V. For Students Currently Enrolled at a College/University :
Approximate credit hours completed by May 2021:
Current GPA:
School activities, honors, offices held, etc.:
VI. Extras:
Professionals in Scrubs Alliance (PSA) administers scholarships designed to offer aid to students that represent unique characteristics. Please check each of the qualifiers below that apply to you. This data may increase your likelihood of qualifying for selected scholarships.
Have you ever received a scholarship from Professionals in Scrubs Alliance?
Do you plan to complete your four-year degree with your college of choice?
Are you a GED recipient?
Are you interested and willing to major in a medical science program (i.e. Nursing, Medical Technology, Physical Therapy, Nuclear Medicine, etc.?
Are you interested and willing to major in Science, Technology, Engineering (Pre-Engingeering) or Math?
Will you be working while attending your college of choice?
If so, will you work:
VII. Essay
Your essay should be 300-500 words. You should address in your essay: your college goals and choice of major, what you intend to do with your education, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Essay:

0/500
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:
(School Name) is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Scholarship Application Form

I. Personal Data:

II. High School Information:

IV. For Transfer Students Only:

V. For Students Currently Enrolled at a College/University :

VI. Extras:

VII. Essay

VIII. Applicant's E-Signature