The Micah Williams Memorial Scholarship Application

Complete all fields and submit application below. You may scroll to the end to save your application to finish later.

Applications are due at 5:00 PM Central Time on Friday, March 3, 2023.

Applicant Information:

Name Email Address Address City

State

Zip Code

Phone

Which of the following best describes you? Select all that apply:
American Indian or Alaskan Native
Asian
Black or African-American
Hispanic, Latino, or Spanish Origin
Native Hawaiian or Pacific Islander
White
Other (Please specify below)
Prefer not to say
Other:

Education

List all schools/colleges attended. Begin with the current institution and end with high school education.

CURRENT EDUCATION

Institution Name Level of Degree Being Pursued Major Minor (if applicable) Credit Hours Completed Credit Hours Remaining to Graduate Current GPA Year Enrolled Anticipated Graduation Year

EDUCATION HISTORY (1)

Institution Name Degree/Credential Achieved Major Minor (if applicable) Credit Hours Completed GPA Years Attended

EDUCATION HISTORY (2) if applicable

Institution Name Degree/Credential Achieved Major Minor (if applicable) Credit Hours Completed GPA Years Attended

EDUCATION HISTORY (3) if applicable

Institution Name Degree/Credential Achieved Major Minor (if applicable) Credit Hours Completed GPA Years Attended

Work Experience:

In chronological order, list any current and previous employers. Include company name, type of work, and dates of employment. Please separate each individual experience with new line.

Awards and Other Recognition:

List any awards or special recognition you have received. Please separate each individual item with new line.

Extracurricular and Community Activities:

List school and community activities that you have participated in during the past three (3) years and your specific involvement. Please separate each individual activity with new line.

Career and Vocational Objectives:

Please briefly describe your career and vocational objective, why you are interested in this career, and state what you consider to be the necessary qualifications.

Personal Statement

In 600 words or less, please provide a personal statement. Include your goals, why you chose to pursue a career in the medical profession and why you believe you should be awarded The Micah Williams Memorial Scholarship.

Either complete in the space below or upload a document.

Upload your Personal Statement:

Required Attachments

Please include your name in the document file names.

Transcripts Two transcripts are required – One copy (1) from the institution you are currently attending and one (1) copy from the institution/school you most recently graduated from. Official transcripts are not required.

Transcript 1:

Transcript 2:

Personal Recommendations At least one (1) and not more than four (4).

Academic Recommendations At least one (1) and not more than four (4).

Certification

By submitting this application, you certify that the information on this application is true and accurate to the best of your knowledge and belief.

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