2026 Scholarship Application
Name
*
First Name
Last Name
Email
*
Phone Number
*
-
Area Code
Phone Number
Mailing Address
*
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?
*
Yes
No
If yes, please list dates of employment and positions held:
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:
*
High School Address:
*
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:
*
Year completed the ACT :
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ACT composite score :
*
College/University you plan to attend this fall:
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Major area of study:
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Essay on future acadamic and career plans:
*
Applicant's Signature
*
Date Signed by Applicant:
*
-
Month
-
Day
Year
Date
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