/* Styling for Tablets */@media only screen and ( max-width: 800px ) and ( min-width:481px ) {}/* Styling for phones */@media only screen and ( max-width: 480px ) {}/*Option to add custom CSS */lang="en-US"> Scholarship Application – Former Recipient - Madison County Health Care System

Madison County Health Care System

Scholarship Application – Former Recipient

Madison County Health Trust Foundation Scholarship Application (Former Recipient)

Complete the application below by April 1 for consideration for a $1,000 scholarship from the Madison County Health Trust, Inc.

Step 1 of 3

Personal Information
Name*
First Last
- Email*
- Daytime Phone*
- Current Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Education
- University or College You Are Currently Attending*
- Major/Program*
- Degree/Certification Pursuing*
- Expected Month/Year of Graduation*
- Official Transcript – Current GPA / Grades*
  Drop files here or
  
  Accepted file types: pdf, jpg, png, gif, Max. file size: 2 MB.
- Class Schedule*
  Drop files here or
  
  Accepted file types: pdf, jpg, gif, png, Max. file size: 2 MB.
  Provide a copy of your future semester’s class schedule.

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Sign & Submit
I have read and agree to the guidelines of this application. I certify all information provided in my application is accurate and hereby request to be considered for the scholarship.
Applicant Signature*
Date*
MM slash DD slash YYYY

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