Fillable Daniel Gilstrap Memorial Scholarship Application (Billings Clinic)

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Daniel Gilstrap Memorial Scholarship Application (Billings Clinic)

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Daniel Gilstrap Memorial
Scholarship Application
2021 Scholarship Application Form
Application Deadline End of Business March 12, 2021
To be eligible for consideration, all documents must be submitted in the format as
shown on this application.
NAME: DOB:
Last First Middle
ADDRESS:
Street City ST ZIP
Primary Phone #
EDUCATION:
High School City Graduation Year
COLLEGE:
Name of college City ST ZIP
Expected Graduation Date (MM/YY)
TYPE OF College: (check one)
□ Four Year College or University
□ Two Year Junior or Community College
□ Vocational/Technical School
Email Address
- 2 -
Type of Health Care Career you are pursuing: (check one)
□ Infection Control Risk Assessment (ICRA)
□ Information Technology
□ Plumber
□ Electrician
□ HVAC Technician
□ Biomedical Technology/engineering
□ Carpentry
□ Clinical Engineering
□ CNC Machine Tool Programer
□ Pipefitter or steamfitter
WORK EXPERIENCE: Describe your work experience during the past three (3) years and how this will help
you as a health care worker. No attachments accepted.
Company Name/Address
Position
Date (from/to)
Other (please specify)
- 3 -
VOLUNTEER ACTIVITIES: List up to four (4) and describe the number of hours volunteered and what you
learned from these experiences. No attachments accepted.
Please use this space to share if there is something unique about you or your family that you would
want the scholarship committee to know as they consider your application.
- 4 -
In 250 words or less, why do you want a career in health care and what qualities do you possess to
succeed in your chosen career?
- 5 -
All applicants sign below:
I certify that the information provided is complete and accurate to the best of my knowledge.
Applicant's Signature
Date
(Your Electronic signature represents an original signature for this purpose
Please submit - one package consists of:
• One (1) copy of this completed application with your original signature.
• One (1) copy of most recent official high school transcript or G.E.D. and current college transcript,
if applicable.
Please email complete package to the following email address.
sseader@billingsclinic.org
Or
Mail complete package to the following address.
Scholarship Committee
Billings Clinic Foundation
PO Box 31031
Billings, MT 59107
Scholarships are awarded to Individuals who exhibit a strong desire and the potential to excel in the
health care field.
Must be postmarked by March 12, 2021. Late or incomplete applications will not be
considered.
Equal Opportunity: Billings Clinic Foundation awards scholarships without regard to race, religion,
creed, age, sex or national origin.
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Daniel Gilstrap Memorial Scholarship Application (Billings Clinic)

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Completed 31 January 2021

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