Apply to the Bruce C. Potter, M.D. Scholarship Step 1 of 3 33% Bruce C. Potter Scholarship ApplicationPlease refer to the Application Instructions for eligibility criteria and submission instructions. Three letters of references must accompany the application for the candidate to be considered. Please request that your school send NAHEC an official transcript of your grades to date. This application must be typed or neatly written. Only complete applications (including all attachments) will be considered. table { font-family: arial, sans-serif; border-collapse: collapse; width: 100%; } td, th { border: 1px solid #dddddd; text-align: left; padding: 8px; } Selection Criteria Academic Achievement Community Engagement Career Plan Character Summary Statement 10% 15% 35% 30% 10% I hereby attest that I have read and understand the application instructions and meet all criteria for eligibility for the Bruce C. Potter Scholarship, to the best of my knowledge.* I agree Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County* Phone (Home)Phone (Cell)Email* College/Training Program Attending Expected Graduation Date Field of Study Degree How did you learn about the Bruce C. Potter Scholarship? I. Academic AchievementPlease ensure that your official transcripts have been sent directly to CNYAHEC.Date Transcript Requested: MM slash DD slash YYYY List all school activities in which you have participated in the past four years (e.g. student government, music, sports).Activity# of YearsSpecial Awards, Honors, Offices Held II. Community EngagementList all community activities in which you have participated without pay during the past four years (e.g. volunteer work, youth club, church work, volunteer work). Note special awards, honors, and offices held.Activity# of YearsSpecial Awards, Honors, Offices Held III. Career Plan1. Describe any paid work experience or activities with which you have participated in the past four years that would serve to support your future career.ExperienceDate BegunDate EndedHrs/WeekType of Work (Experiences) 2. Describe your specific career plan, beginning with the training you are about to enter.School/WorkBeginning YearEnd YearPlanned Outcome (e.g. B.S., R.N., Prep for next position, etc.) 3. Identify if you would like to practice (work) in the area, and if so, for how long. If you are planning on working in the area, please explain why you wish to do so. If not, please explain why you wish to leave the area.IV. CharacterMake sure to have three personal and/or professional letters of references submitted with this application.Describe your personal characteristics. Explain how and why those characteristics fit well with, and support, your career objectives.Upload Reference Letters: Drop files here or Select files Max. file size: 29 MB. V. Summary StatementPlease provide any other information about yourself, your intentions, or your life circumstances that you think are important in the consideration of your candidacy for the Bruce C. Potter Scholarship.
