Kelsey's Courage Scholarship Application

Congratulations on deciding to apply for the Kelsey’s Courage Scholarship. Kelsey Mae Misialek was a bright and energetic 15 year old young lady. Kelsey was ambitious and eager to learn; she wanted to help others and to pay it forward in life. Kelsey was in an ATV crash on June 21, 2012. Kelsey passed away from her injuries 5 days later on June 26, 2012. Her dream was to become an orthopedic surgeon and to be able to help others. This scholarship is made possible by Kevin and Michaela Misialek Family and through community donations.

In honor of Kelsey, one $500 scholarship will be awarded to a North Dakota graduating high school senior. This scholarship is not renewable.

The Kelsey’s Courage Scholarship Foundation will be the final determinate in awarding the scholarship. The award is payable upon proof of your enrollment in the 2nd semester of college towards pursuing a medical degree. The recipient must enroll into a minimum 2 year nursing program or minimum 4 year university to pursue a medical degree.

The scholarship application deadline will be April 1st of each year. Any applications received after that date will not be considered and all verifications, references and documentation must be attached to your application in order to be considered in the determination process.

Name*

First Name Last Name

Parent/Guardian Full Name*

First Name Last Name

Mailing Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Applicant's Local Newspaper (for publication use)*

High School (Include Address)*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

College of Interest*

ACT Score*

GPA (weighted and unweighted, if applicable)*

1. Scholarship Resume including:

Educational history (include ACT & GPA)
Work history (detailed list)
Extracurricular activities (at least 3)
Community service & volunteerism (detailed list)
Community clubs/activities (detailed list)
Career objectives (detailed list)

2. Please attach an essay of 250 words or less on the importance of community service.

3. Please attach an essay of 250 words or less on your career goals, including why you are pursuing a medical career.

4. Please attach verified documentation of a minimum of 50 hours of community service and volunteerism. Documentation must be verified by a high school administer or teacher, minister, businessperson, or recognized community leader.

5. High School Transcript

6. Two letters of reference from high school administrator or teacher, minister, businessperson, or recognized community leader.

7. Recent photo that may be used in any form of public announcement concerning this scholarship.

*

function SvgDhtupload(props) { return /* @__PURE__ */ react.createElement("svg", dhtupload_svg_extends({ width: 54, height: 47, xmlns: "http://www.w3.org/2000/svg" }, props), dhtupload_svg_path || (dhtupload_svg_path = /* @__PURE__ */ react.createElement("path", { d: "M40.213 10.172c1.897.21 3.68.738 5.35 1.58a15.748 15.748 0 014.374 3.242 15.065 15.065 0 012.951 4.533c.72 1.704 1.08 3.522 1.08 5.455 0 1.827-.28 3.654-.843 5.48-.562 1.828-1.379 3.47-2.45 4.929A13.39 13.39 0 0146.669 39c-1.599.948-3.452 1.458-5.56 1.528H37.26a1.62 1.62 0 01-1.185-.5 1.62 1.62 0 01-.501-1.186c0-.457.167-.852.5-1.186.334-.334.73-.5 1.186-.5h3.848c1.44 0 2.75-.37 3.926-1.108a10.851 10.851 0 003.03-2.846 13.53 13.53 0 001.95-3.9 14.23 14.23 0 00.686-4.321c0-1.582-.316-3.066-.949-4.454a11.623 11.623 0 00-2.582-3.636 12.857 12.857 0 00-3.742-2.478 11.054 11.054 0 00-4.48-.922l-1.212-.053-.37-1.159c-.878-2.81-2.292-4.998-4.242-6.562-1.95-1.563-4.594-2.345-7.932-2.345-2.108 0-4.005.36-5.692 1.08-1.686.72-3.136 1.722-4.348 3.005-1.212 1.282-2.143 2.81-2.793 4.585-.65 1.774-.975 3.68-.975 5.718h.053l.105 1.581-1.528.264c-1.863.316-3.444 1.317-4.744 3.004-1.3 1.686-1.95 3.584-1.95 5.692 0 2.39.8 4.462 2.398 6.219 1.599 1.757 3.488 2.635 5.666 2.635h4.849c.492 0 .896.167 1.212.5.316.335.474.73.474 1.187 0 .456-.158.852-.474 1.185-.316.334-.72.501-1.212.501h-4.849a10.08 10.08 0 01-4.374-.975 11.673 11.673 0 01-3.61-2.661 13.173 13.173 0 01-2.478-3.9A12.073 12.073 0 010 28.301c0-2.706.755-5.148 2.266-7.326 1.511-2.178 3.444-3.636 5.798-4.374.14-2.354.658-4.542 1.554-6.562.896-2.02 2.091-3.777 3.584-5.27 1.494-1.494 3.25-2.662 5.27-3.505C20.493.422 22.733 0 25.193 0c1.898 0 3.637.237 5.218.711 1.581.475 3.004 1.151 4.269 2.03a13.518 13.518 0 013.268 3.215 18.628 18.628 0 012.266 4.216zm-11.964 13.44l6.22 6.85c.245.247.368.537.368.87 0 .334-.123.642-.369.923l-.421.263c-.211.246-.484.343-.817.29a1.544 1.544 0 01-.87-.448l-3.69-4.11v16.97c0 .492-.166.896-.5 1.212-.334.316-.729.474-1.186.474-.492 0-.896-.158-1.212-.474-.316-.316-.474-.72-.474-1.212V28.25l-3.584 4.005a1.544 1.544 0 01-.87.448.959.959 0 01-.87-.29l-.42-.264c-.247-.28-.37-.588-.37-.922 0-.334.123-.624.37-.87l6.113-6.746v-.052l.421-.422a.804.804 0 01.396-.29c.158-.053.307-.079.448-.079.175 0 .333.026.474.079.14.053.281.15.422.29l.421.422v.052z", fill: "none" }))); }

I hereby make application for the Kelsey’s Courage Scholarship and certify the information provided is true and correct.*

Powered by Jotform Sign Clear

The money accompanying the scholarship will be made to the college upon official proof of enrollment in the student’s second semester. The school the student chooses to attend must be accredited by one of the officially recognized accrediting agencies.

Student receiving The Kelsey’s Courage Scholarship must begin their education no later than September 5th of the year the scholarship is awarded. Exceptions for time of enrollment may be made upon proper request, and with the approval of Kelsey’s Courage Scholarship Foundation.

Any questions or concerns may be directed to Michaela Misialek at kelseyscourage@hotmail.com.

Kelsey's Courage Scholarship Application

Please attach the following: