HEALTH
PLAN SCHOLARSHIP APPLICATION
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Scholarship
Information: The Health Plan Scholarship is available to full-time, regularly enrolled, significantly
financially needy (as determined by results from the Free Application for
Federal Student Aid - FAFSA) nursing (BS) and medical students (MD) who are
originally from the Health Plan Service Area and intend to practice in the
Health Plan Service Area after graduation.
The scholarship is intended to offset educational costs (tuition and
fees and required books & supplies and equipment). For consideration, submit this application
with a current resume or curriculum vitae by May 1st.
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PLEASE PRINT OR TYPE THE FOLLOWING
INFORMATION Full Name _____________________________________________________________________ WVU Student Number
___________________________________________________________ *Local Address
_________________________________________________________________ _______________________________________________________________________________ Local Phone
Number ( )
_____________-___________________________________ WVU Mix Email
______________________________Major ____________________________ Year in School 2012-2013________Expected Graduation
Date ___________
Month/Yr |
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Explain in the space provided: your commitment to practicing in the Health
Plan area, your current financial situation, why you have chosen a career in
healthcare and any additional information for which you feel would support
your request for scholarship assistance.
You may attach up to one additional page if necessary. |
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Attach current curriculum vitae or
resume. My signature below certifies that the
information I have provided on this application is true and complete to the
best of my knowledge. I also agree
that information concerning verification of family income, test scores/grades
and other pertinent information can be shared with Health Plan
representatives for the sole purpose of determining my eligibility to receive
the Health Plan Scholarship. _________________________________
____________________________ ________________________________________ ____________________________________
Signature
Date |
Return the
application to:
Financial
Aid Office
Fax: 304-293-6861
FOR OFFICE USE ONLY
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College GPA |
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Financial Need |
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MCAT |
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Renewal Applicant Y N |
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Committee Member Vote/Comments |
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