2026 GVMH Auxiliary Scholarship Application
Name
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First Name
Last Name
Email
*
Phone Number
*
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Area Code
Phone Number
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently or have you ever been employed by Golden Valley Memorial Healthcare?
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Yes
No
If yes, please list dates of employment and positions held:
Have you ever been a volunteer for GVMH?
Yes
No
If yes, please list dates and duties performed:
Do you have a relationship with anyone affiliated with Golden Valley Memorial Healthcare?
*
Yes
No
If yes, please provide name and relationship:
Educational Information
Name of High School Attending:
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High School Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Expected to Graduate:
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-
Month
-
Day
Year
Date
Most recent cumulative GPA:
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Academic awards and/or honors you received in High School:
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High School activities, community activities, volunteer work, honors and/or offices held:
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College/University you plan to attend this fall:
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Major area of study:
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Short Essay on your interest and goals in pursuing healthcare education:
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Applicant's Signature
*
Date Signed by Applicant:
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-
Month
-
Day
Year
Date
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