Pathways to Equity Scholarship Application

Pathways to Equity Scholarship Application

For Students Pursuing a Career in Healthcare
The Pathways to Equity Scholarship is funded by private donors and administered by Nehalem Bay Health Center & Pharmacy. It supports short-term healthcare training for Tillamook County residents. The program must lead to a recognized credential (degree, certificate, diploma, license, certification, or registration). Applicants must meet their school’s program enrollment requirements; the scholarship does not enroll students. Award amounts are determined individually and do not automatically renew.
Pathways to Equity Scholarship Applicant Information Sheet

Applicant Information & Contact Details
Name

First NameLast Name
Date of Birth (MM/DD/YYYY)

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address different from your physical address?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant Education & Intended Program
High School Attended
Graduation Year
YYYY
Intended Healthcare Program
Examples: Nursing, Medical Assistant, Nurse Assistant, Phlebotomy, Medical Interpreting, Billing and Coding, Behavioral Health, etc.
Please select your current enrollment status.

Scholarship Expenses

Rows	Amount Requested ($)
Tuition
Books and Supplies
Professional Fees (Licensing, Exams)
Uniforms
Transportation
Childcare
Other Expenses

Total Scholarship Amount Requested
If you entered an amount for Other Expenses above, please describe those expenses here; otherwise, leave blank.
Do you have other financial assistance such as grants, loans, and savings? Please explain.

Personal Statement
Please respond to the following questions.
Career Goals — Why do you want to pursue a career in healthcare?
Overcoming Barriers — Describe any obstacles you have faced in accessing education or employment, and how you have worked to overcome them.
Community & Equity Impact — How do you plan to use your healthcare career to support your community or address equity gaps in healthcare access?
After completing your program, is it your intention to prioritize local employment opportunities? Priority is given to those who intend to return to their communities to strengthen their workforce.
Please explain your answer about local employment intentions.
Is there anything else you would like to share with us related to your educational goals or needs?