Osteopathic Foundation of West Michigan · 2023-2024 OsteoScholars RETURNING Student Application (Renewal)

INSTRUCTIONS

Students are expected to demonstrate their communication skills by submitting the application and attachments independently and according to the directions in the form.

Please return the application and document as soon as possible. Spots will be reserved on a first-come basis.

STUDENT INFORMATION

Name

*

First Name

Last Name

Preferred Name

Date of Birth

*

(mm/dd/yyyy)

Gender Identity (Optional)

Ethnicity (Optional)

Race (Optional)

Check all that apply:

Amer. Indian

Alaskan Native

Black/Afr. Amer.

White/Caucasian

Asian

Pacific Is.

Other

Applying for:

*

OsteoScholars 2023/2024

CONTACT INFORMATION

Student's Email

*

Most of our communications will be provided through email. Please provide an email address that you check on a regular basis.

Verify Email

*

School Email Address:

Please provide the email address provided by your high school.

Verify Email

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Phone

Cell Phone

*

SMS Messaging

*

By checking the box below, I agree to add my number to the list to receive program notifications by text/sms messaging. To start this service, I must opt-in by responding to the initial text.

Yes, please add me to the list using the cell number I provided.

No, I am not interested at this time.

No, I do not have a cell phone of my own - I will need to ask a parent/guardian to use theirs.

EDUCATION

High School

*

Cumulative GPA

*

Graduation Year

*

2023-2024 Grade

*

PARENT/GUARDIAN INFORMATION

Provide parent/guardian information below. Space is provided for two parents/guardians; however, only one is required.

Parent/Guardian Name

*

First Name

Last Name

Relationship to Student

*

Parent/Guardian Email Address

*

Verify Email

*

Parent/Guardian Phone Number

*

Parent/Guardian Name (#2)

First Name

Last Name

Relationship to Student (#2)

Parent/Guardian Email Address (#2)

Verify Email

Parent/Guardian Phone Number (#2)

SIGNATURES

I affirm that the statements on this application are true, complete, and correct. I hereby authorize the Osteopathic Foundation to make any inquiries deemed necessary concerning the information provided. Completion of names and submission of form will constitute legal electronic signatures. Students, be sure your parent/guardian is informed of your application. Ask them to type in their name in the signature field.

Student Signature

*

Parent/Guardian Signature

*

REQUIRED ATTACHMENTS:

TRANSCRIPT. Provide a current, unofficial copy of your high school transcript.

SUBMIT REQUIRED ATTACHMENTS HERE:

*

Please combine your documents into one PDF file to upload.