Post-Graduate Healthcare Careers Scholarship
Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
Date
Email Address
*
Confirmation Email
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Besides English, any additional languages spoken
School
*
Major
*
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Gender Identity
*
Male
Female
Non-binary
Other
Sexual Orientation
*
Asexual
Bisexual
Gay
Heterosexual or straight
Pansexual
Queer
None of the above
Race
*
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Current Kern Medical Volunteer
*
Please Select
Yes
No
Department
*
Total Number of Hours Volunteered at KM
*
Other Community Service
Transcript
*
Browse Files
Drag and drop files here
Choose a file
Please upload a copy of your transcripts, showing date of degree completion or expected
Cancel
of
Essay - How will this scholarship benefit your pursuit of a career in healthcare?
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Letter(s) of Recommendation
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: