Altus Scholarship Application 2022

Scholarship Application Form

The application deadline - March 31st, 2022
Read and Understand the instructions. *

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
Choose your location *
I. Applicant Data:

Tell us about yourself
Full Name *

First Name Last Name
Birthdate: *

Month Day Year
Phone: *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to
Home Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother's Name

First Name Last Name
Mother's Occupation & Employer
Father's Name

First Name Last Name
Father's Occupation & Employer
Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards.
Do you plan to attend College or Technical Program:

College Technical Program
College or Technical Program #1
Are you a US citizen?

Yes No
Status at the time of application: *

I will graduate in May / June of 2022 I will be an incoming freshman graduating high school prior to 2022 I have attended college but have less than 32 college credit hours I have attended college but have at least 32 or more college credit hours I am a GED graduate with no college credit hours
Are you a first generation college student ?

Yes, I am the first among my parents or grandparents to attend college. No, either my parents or grandparents have attended college.
Major Area of Study:
What is your Career Objective:

0/300
II. High School Information:
Will you graduate prior to Fall 2022?

Yes No
May 2022 high school graduates are eligible for consideration for summer scholarships in addition to fall-spring awards. Accepting a summer award obligates you to attend in the following fall and spring.
High School Attended: *
Year of High School Graduation:
Most recent cumulative GPA: *
Upload Transcript: *

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Upload Two (2) References (Letters of Recommendation) *

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High School activities, community activities, volunteer work, honors, offices held:
If you attended a junior college please list the cumulative transfer GPA:
III.Questions
1. In 100 words or less, explain why you chose a career in healthcare. *
2. In 100 words or less, give a brief description of your involvement in school/ community activities. *
2. In 100 words or less, give a brief description of where you see yourself five years from now. *
IV. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Altus Emergency is committed to equal opportunity in employment and education. Altus Emergency Centers does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
Should be Empty:

Scholarship Application Form

I. Applicant Data:

II. High School Information:

III.Questions

IV. Applicant's E-Signature