General Scholarship Application

H.E.A.L. Scholarship

Helping Empower Aspiring Leaders in Healthcare
Full Name*

First NameLast Name
E-mail*
Enter E-mail Here
Mobile Phone Number*
Address

Street Address

Apt/Unit #

CityState

Zip Code
Are you currently employed in a long-term care setting?*
Yes or No
Describe your current role or area of study*
How did you hear about this scholarship?*
Website, Flyer, Social Media, Word of Mouth, Other
Upload Your Personal Statement*

Submit a 300–500 word personal statement
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Upload Proof of Enrollment or Plans*

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I certify that the information provided is accurate and true. I understand that the scholarship funds must be used for educational purposes, and if selected, I agree to participate in an announcement for the H.E.A.L. Fund Scholarship.

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H.E.A.L. Scholarship