Name (as you would want it printed in an awards ceremony program or on a plaque/certificate)
Name Pronunciation (please spell out your full name phonetically)
Current Mailing Address (include city/state/zip)
Hometown (city and state where you grew up)
Undergraduate Institution
Are you a first-generation college student?
Hobbies/Interests (non-academic)
Previous Career(s)/Job(s) or "Student," if none
What inspired you to pursue your health sciences career path?
Describe the biggest challenge you overcame on your path to WesternU.
Why did you choose to attend WesternU?
In what activities are you involved at WesternU?
What is the best thing about being a WesternU student?
What is your proudest accomplishment?
THANK YOU NOTE: It is important that you acknowledge your scholarship's donor’s generosity by submitting a thank you note. Scholarship donors are thoughtful and caring people who unselfishly give financially to support educational endeavors of students like you. Your letter reminds them why they gave in the first place and often helps to secure continuing support for future scholarships. (Be aware that donors provide money for scholarships but do not select recipients, so do not thank them for “choosing” you.) Be sure to include the following in your message: 1) Thank the donor for the scholarship. Mention the scholarship’s name and how you are qualified for it. (For example, if your award is related to pediatrics, share that you are planning to pursue pediatrics.) 2) How will this scholarship impact you? 3) What are your future career plans/goals? 4) What impact are you hoping to make on the community you serve? 5) Close your message with your name, program and year (e.g. Jane Doe, DO Class of 2027) Please proofread your message and pay attention to spelling, grammar and punctuation. Your message may be edited and formatted into a formal letter and sent to the donor(s) or their family.
Photo (headshot; hi-res but no more than 10MB)
CONSENT: Do you consent to the University using information from your application and this questionnaire, such as your name, program, class year, photo, and quotes from your essay(s) and thank you note, but no personal contact information, for online and print promotional purposes?
