Osteopathic Foundation of West Michigan · 2022-2023 OsteoScholars Student Application

INSTRUCTIONS

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

Applications will be accepted through May 15, 2022 or until the program is full, whichever comes first.

STUDENT INFORMATION

Name

*

First Name

Last Name

Preferred Name

Date of Birth

*

(mm/dd/yyyy)

Applying for:

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OsteoScholars 2022/2023

CONTACT INFORMATION

Email

*

Verify Email

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Phone

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Cell Phone

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EDUCATION

High School

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Cumulative GPA

*

Graduation Year

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2022-2023 Grade

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REFERENCE

Provide the email address of a high school teacher, principal or counselor who has agreed to provide a reference. We will email a link to a brief online survey.

Reference Name

*

Reference Email Address

*

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

*

First Name

Last Name

Relationship to Student

*

Parent/Guardian Email Address

*

Verify Email

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Parent/Guardian Phone Number

*

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

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Parent/Guardian Signature

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REQUIRED ATTACHMENTS:

PERSONAL STATEMENT. Write a brief personal statement describing your career interests and what sparked your interest in the medical field. (250-300 words, typed)
EXPERIENCE. Please list school activities, community involvement, and volunteer experience.
TRANSCRIPT. Provide a current, unofficial copy of your high school transcript.

SUBMIT REQUIRED ATTACHMENTS HERE:

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Please combine your documents into one PDF file to upload.