Scholarship Application

NOTE: Please include your first and last name in all files submitted online.
Contact Information
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Do you work?


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Are you employed with SoutheastHEALTH?

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Do you expect to receive other financial aid?

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Program Information
Course of Study




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Level of Study




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Financial Need and Career Goals
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Applicant Certification
I certify the information contained in this application is true, complete and correct to the best of my knowledge and that all funds will be used for enrollment expenses related to the program in which I am entering or enrolled. I hereby authorize the release of personal, scholastic and financial information related to my educational status to SoutheastHEALTH Foundation from any academic institution I have attended in the past and any academic institution in which I am enrolled or may be enrolled as a future student. I further waive my right to view any reference letters submitted on my behalf.

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Submission Instructions
Submitting on or before May 31

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