Produced by LCCC Public Relations PRS 9237 5/12
West Nebraska Blood Center
SCHOLARSHIP APPLICATION
Application Deadline: April 1
Name
First, Last, Middle
Mailing Address
Street
City, State, ZIP
Phone Number Date of Birth
Social Security Number
High School Attended
Ranking in Graduating Class Date of Graduation GPA
Are you presently enrolled in college?
Yes No
What college will you be attending?
What is your major?
Which Laboratory Medicine profession do you intend to pursue?
Undergraduate Year: FR SO JR SR
What is your current college GPA?
(unless applying for freshman collegiate year)
Estimated cost of next academic year beginning (MM/DD/YYYY)
Tuition Fees Books
Other (please explain)
Please submit a formal letter of application. The letter should include an explanation
of your interest in the chosen laboratory medicine field, future career plans, and a
brief account of your financial reasons for applying for this scholarship. Any other
information which may be relevant to the selection process may also be included in
the letter.
By checking this box, I hereby certify the provided information is accurate to the
best of my knowledge. I also certify that I will allow the Scholarship and Financial
Aid Office at LCCC to release any information that is applicable to this application.
If selected, I intend to use this scholarship in the pursuit of a career in the filed of
laboratory medicine.
_____________________
Date
