Exploring Careers in Healthcare Summer Day Camp Scholarship

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Exploring Careers in Healthcare Summer Day Camp Scholarship

Scholarship Form

To be considered for a need-based scholarship, please complete the following form. Decisions on scholarships will be made on a rolling basis, as funds are available.

1. First Name: Required

2. Last Name: Required

3. Address: Required

4. Telephone Required

5. Date of Birth Required

6. Parent's Names Required

7. Total number of exemptions on federal income tax form Required

8. Adjusted gross income Required

9. US income tax paid last year Required

10. What amount can you contribute to the tuition for Exploring Careers in Healthcare Camp Required

11. Email