BW COF STEM Healthcare Scholars Program Graduate/Post-Bacc Application 2024-25

Questions with an asterisk (*) indicate that a response is required.

First Name *

Last Name *

Middle Initial

BW Student ID (if known)

Date of Birth *

Current Address *

City *

State *

Zip Code *

Main Phone *

May we text you? *

Email *

What is your gender identity? *

Race and Ethnicity definitions:

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.
Black or African American. A person having origins in any of the black racial groups of Africa.
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

What is your racial identity?
(Please check all that apply)

African American

American Indian / Alaska Native

Asian

Hispanic/Latinx

Native Hawaiian / Other Pacific Islander

White

If there is additional information about your racial or ethnic heritage that you would like us to know, please submit it here.

Will you be a full-time or part-time student at BW? *

Is English your first language? *

Are you an adult student (defined as a student over the age of 26)? *

Do you have any dependents? *

Are you a displaced worker? *

What, if any, is your military affiliation?

EDUCATIONAL INFORMATION

Bachelor's Degree and Major (E.g., BS Biology) *

School where earned *

City, State *

Year earned *

Have either of your parents earned a bachelor’s degree? *

Final GPA *

Graduate and post-bacc programs eligible for this Choose Ohio First Award are:

Accelerated Bachelor of Science in Nursing, Clinical Mental Health Counseling, Exercise Physiology, Physician Assistant, Public Health, and Speech Language Pathology.

Intended Program *

Accelerated Bachelor of Science in Nursing (BSN)

Clinical Mental Health Counseling

Physician Assistant (MMS)

Public Health (MPH)

Speech-Language Pathology (MSLP)

ESSAY QUESTIONS

These essay questions help us learn about you in ways that go beyond what your educational information alone can convey. Please use this opportunity to tell us what makes you unique. Both essays are required; please include them in a single document and attach it below. Be sure to include your name on the document and in the file name. There is no set length requirement, but 300 to 500 words is a general guideline.

1. Describe what you find compelling about the healthcare field that you have chosen to pursue. What initially inspired your interest and what motivates you to persist? If you have thought about your ideal career in this field, what might it be?

2. One challenge that this grant seeks to examine is the disparity in healthcare availability in rural Ohio. Please express your thoughts on this topic, including how you might benefit personally and professionally from exposure to this issue. *

REFERENCE INFORMATION

We will review the information that you have submitted with your BW application. Please provide us with contact information for an additional reference with whom we can follow up as necessary.

Nominator *

Job Title

School or Organization

Relationship to Applicant

Years known Applicant

Email *

SIGNATURE

By signing this document, I acknowledge that I have completed all content in this COF STEM Healthcare Scholars Program Application and it is current and accurate.

I have also read and understand that if chosen as a COF STEM Healthcare Scholar, I will be required to:

-Participate in the program's coaching, educational, social, and professional development activities

-Maintain Good Academic Standing and earn a minimum grade point average each semester of 3.0

-Declare an eligible STEM Healthcare major and enroll in related coursework each semester

-Participate in work-based learning and exploration of opportunities in rural healthcare

Signature of applicant * 🛈

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