Scholarship Trustee Application

Trustee Scholarship

Colquitt Regional Medical Center is proud to offer an annual scholarship to a student pursuing a career in healthcare. This scholarship is given by the Hospital Authority of Colquitt County Trustee Members.
Any student who has completed his/her core studies and is already in or has already been accepted into a healthcare-related field of study is eligible to apply.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Next of Kin and Relationship:*
GPA*
SAT (V)
SAT (M)
ACT (V)
ACT (M)
Name of school you are presently attending:*
Colleges to which you have been accepted:*
Have you applied for financial aid at the college you were accepted?*
Have you filed the financial aid form FAF? The SIG?*
Have you already been informed that you will receive a scholarship or financial aid?*
If yes, please include amount.
What healthcare field do you plan to major in at college?*
Briefly explain how you decided on this field.*
List of extracurricular activities for grades 9-12, honors received inside and/or outside of school.*
Essay (500 word or less) on your plans and goals after completing the program*

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Letter of acceptance into school for healthcare program/courses*

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High School Transcript*

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College Transcript*

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SAT/ACT Scores*

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One reference letter from each of the following: Education field, Medical field, and Community*

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Should be Empty:

Trustee Scholarship