General Scholarship Application

2023-2024 WICHE PSEP Application
APPLICATION REQUIREMENTS: Deadline - OCTOBER 15, 2022

Late applications may be accepted and will be considered after those submitted on time.

Thank you for your interest in the Western Interstate Commission for Higher Education (WICHE) Professional Student Exchange Program (PSEP). Utah participates in the Optometry and Podiatry programs.

Please refer to the WICHE website for additional program details, including a listing of participating institutions. Admission requirements vary from institution to institution, but it is usually to your advantage to apply early. Submitting an application for WICHE PSEP support does not guarantee admission to an institution. Application to institutions that are not WICHE participants will have no bearing on your eligibility for certification.

Key Application Requirements
- To be considered, applicants must demonstrate 5+ years of Utah residency prior to applying.
- You will need to submit the following documents when submitting this application
  - A copy of your undergraduate transcripts;
  - A copy of your graduate transcripts (if currently enrolled);
  - A signed Consent Form (press the Ctrl button to open this link in another tab)
Note - This application will need to be completed in one session. You will not be able to save your progress and return later. Before you start, please have all of the necessary information to complete the application.

A completed and approved application does not guarantee funding; state legislative appropriations determine the number of students the state can support each year.
Application for certification in *
Full Name *

First Name Last Name
Preferred Name
Date of Birth *

Month Day Year
List of colleges to which you're applying *
Gender
Completion of this question is voluntary. Sharing this information will not impact your eligibility to receive support.
Ethnicity
Completion of this question is voluntary. Completion of this question is voluntary. Sharing this information will not impact your eligibility to receive support.
Current Telephone Number *

Area Code Phone Number
Email *
Enter E-mail Here
Current Address *

Street Address

Apt/Unit #

City State

Zip Code
Is your permanent address different from you current address? *

Yes No
Permanent Address *

Street Address

Apt/Unit #

City State

Zip Code
Previous addresses during the past five years *
If same as above, please indicate that here.
Birthplace *
Parent 1 Name and Address *
Parent 2 Name and Address *
Current undergraduate overall GPA *
Complete list of high schools attended *
Complete list of colleges or universities attended *
Related work experience
I am currently enrolled as a class* in major subject* at institution*. I expect to complete all requirements for admission to a school of * by Date* .
I have been a legal resident of state* since date*.
My parents have been legal residents of Type a label* since date (month & year)*.
If you do not live in Utah, explain how you qualify as a Utah resident:
Acknowledgment and Signature

I expect to return to Utah to practice my profession if I participate in this program. I understand that continuation in the WICHE program is subject to legislative appropriations each year, and that I may be required to pay a portion of the WICHE or contract fee to the state as may be determined by the Legislature or the Utah State Board of Higher Education. I certify that all statements and dates herein are true to the best of my knowledge.
Signature *

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Upload Consent Form *

Upload a File
Upload signed Consent Form here Cancel of
Upload College Transcript(s) *

Upload a File
Upload College Transcript(s) here Cancel of
The State of Utah provides WICHE support for a limited number of students in the fields of Optometry and Podiatry. If you have questions regarding any part of this application, the requirements for this program, or would like additional information, please contact the Utah Certifying Officer, Cassidy Stortz, via email cstortz@ushe.edu or by telephone (801) 646-4807.
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2023-2024 WICHE PSEP Application

Acknowledgment and Signature