2026 Marshall Bailly "Senior" Memorial Scholarship Nomination Form

2026 Marshall Bailly "Senior" Memorial Scholarship Nomination Form

Please complete this form to nominate students to apply for the Marshall Bailly "Senior" Memorial Scholarship. Nominations are reviewed within 72 hours and sent out via email. Nominators will be cc'ed on the email.
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 2026 Marshall Bailly "Senior" Memorial Scholarship, which provides one student with a full-tuition scholarship to participate in the Leadership Initiatives Advanced Medical & Public Health Internship. The Bailly 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.
Should be Empty:

2026 Marshall Bailly "Senior" Memorial Scholarship Nomination Form

Student Scholarship Nomination Information