Scholarship Application


Scholarship Application

Please complete the form below, which contains information about why you feel you are the best candidate for the available scholarships.  You will be asked to submit a short 500 word essay, and your college transcripts. 


First Name: *
Last Name: *
Email Address: *
Address: *
City: *
State: *
Zipcode: *
College or University: *
Degree Program: *
Award Choice: *
Katrina Kehlet Graduate Award
The Veterans Award
The Undergraduate Award
How do you intend to impact the arena of Healthcare Informatics and/or Healthcare Technology? (500 word maximum - Attach document here) : *
A copy of your Transcript is required. (Please attach your transcript here): *