WHF | Scholarship Application
Personal Information (1/5)
We will use this information to communicate with you in the selection and awarding process. WCHS HR will also be using this information to contact you regarding hiring opportunities.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you an enrolled member of a federally recognized tribe?
*
Please Select
yes
no
Are you an employee of Winnebago Comprehensive Health System?
*
Please Select
yes
no
Have you ever received a Winnebago Health Foundation scholarship?
*
Please Select
yes
no
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Demographic and Financial Information (2/5)
Tribal Enrollment Number:
*
Name of Enrolled or Principal Tribe:
*
Are any of your family members enrolled in a tribe? Please check all that apply.
*
Child
Spouse
Mother
Father
Grandparent(s)
None / Not Applicable
Other
What is your job title at WCHS?
*
e.g. nurse, CNA, MA
Gender Identity
*
Please Select
Woman
Man
Transgender
Non-binary/non-conforming
Prefer not to respond.
Do you qualify for free/reduced lunch or other federal assistance programs?
*
Please Select
yes
no
In which branch (if any) of the United States military have you served?
*
Please Select
Air Force
Army
Coast Guard
Marine Corps
Navy
I have not served in the military
Marital Status
*
Please Select
Single
Married
Separated
Divorced
Widowed
Number of dependents:
*
Use this feild to indicate the number of people, if any, who rely on you for financial support and care.
How do you plan to pay for college/university next semester? Please check all that apply.
*
Tuition is fully covered by the Winnebago Tribe of Nebraska.
Tuition is fully covered by some other funding source (other tribe, grant, scholarship)
Tuition is partially covered by the Winnebago Tribe of Nebraska
Tuition is partially covered by some other funding source (grant, scholarship)
Personal Funds (Full or part-time employment)
Personal Savings
Family/parent/caregiver funds
Student loans
Other
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Educational Background (3/5)
What High School did you attend / are attending?
*
Date (or expected date) of high school graduation or GED completion.
*
-
Month
-
Day
Year
If exact date is unknown use 1 for day, e.g., 05/01/2026.
What is your current or cumulative GPA:
Please provide either your high school or college GPA out of 4.0 as applicable. If you have not been in college or high school for the past 5 years feel free to leave this field blank.
Name of College/University you are attending/ plan to attend?
*
What is your current or planned major/minor?
*
Choose the option to accurately complete the following sentance: Next semester, I am attending college/university...
*
Undergraduate Full Time (≥12 credit hours)
Undergraduate Part Time
Graduate School Full Time (≥ 9 credit hours)
Graduate School Part Time (< 9 credit hours)
Other
What is your expected date of college/university graduation?
*
-
Month
-
Day
Year
If exact date is unknown use 1 for day, e.g., 05/01/2026.
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Accomplishments & Personal Statements (4/5)
How did the scholarship(s) you received in the past benefit you?
*
How have you contributed to the Winnebago community?
*
You may want to complete this information on a word or google doc and then paste in the field.
Tell us about yourself and clearly express what you want to do with your degree and how this will benefit the Winnebago community and the capacity of the Winnebago Comprehensive Health System.
*
You may want to complete this information on a word or google doc and then paste in the field.
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Please attach a picture of yourself that will be used for scholarship announcement purposes.
*
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Note: Photo submitted must be a “taken” photo, not aselfie. Must be headshot (taken fromthe shoulders up) and professional in style and content. Please do not wear any headwear to includeheadphones, earphones, hats, bandanas, sunglasses,etc. Photo should have a solid or non-distracting background Photo submitted must be of high-quality, full color. Please be weary of blurry or pixelated shots. Submitted photo must not contain any individuals except for the scholarship applicant (with the exception of the scholarship applicant’s children). Please no croppedgroup photos. Photo submitted should not have any unnatural filters (please noSnapchat or other app filters. Photosubmitted should not be a photo of a printed picture.
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Alternative Contact Information (5/5)
Please provide the contact information for the person with whom we may communicate if we are unable to reach you.
Secondary Contact Name
First Name
Last Name
Secondary Contact Relationship
(e.g. mother, father, aunt)
Secondary Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact Email
example@example.com
Do you identify as a protected veteran?
Please Select
Yes, I identify because I am currently serving in the US armed forces.
Yes, I identify because I have served in the US armed forces.
No, I do not identify as a protected veteran.
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