2024 Dr. Paul Kostecki Memorial Scholarship Nomination Form

2024 Dr. Paul Kostecki Memorial Scholarship Nomination Form

Please complete this form to nominate students to apply for the 2024 Dr. Paul Kostecki Memorial Scholarship. Nominations are reviewed within 72 hours and sent out via email. Nominators will be cc'ed on the email.
The Dr. Paul Kostecki Memorial Scholarship is closed for the 2024 application cycle. The 2025 Leadership Initiatives Full Scholarships open on September 15th, 2024 for the 2025 Summer Internship Programs.

To learn more about Leadership Initiatives Summer Internship Programs, please visit www.LIChangeSummer.org.
Nominator Name*

First NameLast Name
Nominator Email Address*
Note: Leadership Initiatives requests your email to confirm receipt of your student nominations and to keep you aware of future nomination opportunities. Your personal information and that of your nominees is stored securely and never shared. We have worked with students from across the globe for more than 15 years, and we maintain a strict, comprehensive privacy policy.
Preferred Phone (Not Required):
High School or Organization Affiliation *
Student Scholarship Nomination Information
Nominate an outstanding high school student to apply for the 2024 Dr. Paul Kostecki Memorial Scholarship, which provides one student with a full-tuition scholarship to participate in the Leadership Initiatives Advanced Medical Neuroscience Internship. The Kostecki Scholarship Fund will provide fifteen additional students with partial scholarships to attend a summer internship.

Any HOSA students with an interest in education, public health, medicine, healthcare, or child development are eligible to apply. Students will be asked to write a two-page interest statement as part of the application process.
Student Name*

First NameLast Name
Student Email*
Student Graduation Year
Student Phone Number (optional)
Would You Like To Nominate Another Student?

YesNo
Student Name*

First NameLast Name
Student Email*
Student Phone Number (optional)
Student Graduation Year
Would You Like To Nominate Another Student?*

YesNo
Student Name*

First NameLast Name
Student Email*
Student Graduation Year
Student Phone Number (optional)
Would You Like To Nominate Another Student?*

YesNo
Student Name*

First NameLast Name
Student Email*
Student Graduation Year
Student Phone Number (optional)
Would You Like To Nominate Another Student?*

YesNo
Student Name*

First NameLast Name
Student Email*
Student Graduation Year
Student Phone Number (optional)
If you would like to nominate another student, please complete the form again.
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2024 Dr. Paul Kostecki Memorial Scholarship Nomination Form

Student Scholarship Nomination Information