Yuma Regional Medical Center
 
 

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2014 Scholarship Application - Choose one 
Please check the box that describes your current status 


Student First Name: 
Student Last Name: 
Phone Number: 
Mailing Address: 
City: 
State: 
Zip: 
Email Address: 
Name of School (High School): 
Check here if you attended: 

Dates Attended From:  Calendar (mm/dd/yyyy)
Dates Attended To:  Calendar (mm/dd/yyyy)
Did you graduate or are you currently enrolled?: 

Cumulative GPA: 
Name of School (Post-Secondary (if applicable)): 
Dates Attended From:  Calendar (mm/dd/yyyy)
Dates Attended To:  Calendar (mm/dd/yyyy)
Did you graduate or are you currently enrolled?: 

Cumulative GPA: 
Name of School (Graduate (if applicable)): 
Dates Attended From:  Calendar (mm/dd/yyyy)
Dates Attended To:  Calendar (mm/dd/yyyy)
Did you graduate or are you currently enrolled?: 

Cumulative GPA: 
Preference will be given to students who have previous health-related volunteer experience, especially for graduating high school seniors. Please list all volunteer experience(Organization, Volunteer Role, Dates Volunteered, Contact Name): 
Name of academic institution that you will be attending during the 2014-2015 school year: 
Have you been accepted for enrollment or are currently enrolled? 

Are you enrolled full- or part-time?  

Expected graduation date: 
Current Year: 



What is your current or proposed field of study?  



If Other, please specify:

Will you be employed during the Academic Year? 

If yes, list employer: 
Avg. # of hours/ week: 
Pay per hour: 
Number of dependents? (Do not include yourself): 
Primary source of financial support: 

If Other, please specify:

Are you experiencing extenuating circumstances that are negatively impacting your current financial situation? If so, please briefly (one to two sentences) describe: 
Have you ever received a scholarship from the Foundation of the Yuma Regional Medical Center? 

Do you plan on working in Yuma County post graduation? * 

Attach Your Essay: (Word or PDF) 
Attach Your Resume: (Word or PDF) 
Attach Your Letter of Recommendation 1: (Word or PDF) 
Attach Your Letter of Recommendation 2: (Word or PDF) 
Attach Your Transcripts: (Word or PDF)  
Attach Your Acceptance Letter (if applicable): (Word or PDF) 
Authentication * 

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© 2015   Yuma Regional Medical Center  |  2400 S. Avenue A  |  Yuma, AZ 85364  |  928-344-2000