Auxiliary Health Care Career Scholarship Application

Deadline to apply is April 1.

  • 1. Personal Information

  • 2. Current Education

  • MM slash DD slash YYYY

  • 3. Past Education

  • School NameStart DateGraduation DateSchool Address 
  • School NameStart DateEnd Date 

  • 4. Future Education

  • Name of SchoolField of StudyFor a Degree or Certificate In 
  • Name of ProgramSchool of Program 
  • Name of ProgramSchool of Program 

  • 5. References (Unrelated to Applicant)

  • Reference 1
  • Reference 2

  • 6. Estimated Educational Expenses for 1 Year

  • Expense CategoryExpense Amount: 

  • 7. Uploads / Attachments

  • Max. file size: 50 MB.
  • Max. file size: 50 MB.
    This may include present and future career goals as well as any special circumstances which may have influenced your ability to continue or complete education.
  • Max. file size: 50 MB.

  • 8. Agreement & Signature

    This application and supporting information becomes the property of Western Missouri Medical Center Auxiliary. I certify the information I have furnished is accurate and complete to the best of my knowledge and understand that it may be subject to verification with former employers and other persons. I authorize my past and present employers to supply any information they have concerning me or my work performance during my association with them and release them from all liability in connection therewith. I understand and agree that misrepresentation, falsification, or omission may be considered sufficient cause for rejection. I understand that this award may be taxable in the United States (see IRS tax code for information).
  • MM slash DD slash YYYY

  • We may use your contact information to tell you about health-related benefits or services that may be of interest to you.