Justin J. Slama Memorial Scholarship
PROVIDE A COPY OF THE LETTER OF ACCEPTANCE INTO THE ALLIED HEALTH PROGRAM.
APPLICANT INFORMATION
* = Required Information
First Name
*
Last Name
*
Address
*
City, State Zipcode
*
Phone
*
E-mail
*
High School Attended
*
Year Graduated
*
County Where You Reside
*
Cuming
Dakota
Dixon
Thurston
Wayne
Are you a resident of Nebraska?
*
Yes
No
College Attending
*
ACADEMIC PERFORMANCE & HEALTHCARE EXPERIENCE:
College Grade Point Average
*
College transcript and copy of acceptance letter or notification of acceptance must be submitted. If not submitted, please give explanation.
Submit copies to:
Justin J. Slama Memorial Scholarship
Attn: Kelly Kaup
PO Box 100
Pender, NE 68047
Healthcare Experience
*
My career objective in three hundred words or less. Please relate your career objectives to the health needs of people living in rural areas.
*
College and community activities. (List activities, service clubs, work experience, etc.).
*
FINANCIAL NEED:
Cost of program for one year.
Tuition
Books
Room/Board
Travel
Other
Total
RESOURCES AVAILABLE:
Other Scholarships
Pell Grant
Employment
Loans
Family Assistance
Reserves
Other
Total