Doctors Goodwill Foundation

Doctors' Goodwill Foundation Scholarship Application

The Doctor's Goodwill Foundation has developed the following opportunity to assist students, desiring to enter the medical field with learning costs. Any student enrolled in an Allied Health Program in need of financial assistance will be considered as long as they meet the criteria. Awards will be applied to tuition and books for the academic year.

Applicants must meet the following criteria:

Must be a resident of Brevard County (can be attending an out of County or State College, however primary home must be in Brevard)
May be asked to personally interview with the DGF committee.
Scholarship funds may be funded in one of two ways:
1. Recipients can submit receipts totaling scholarship award prior to receiving payment.
2. Funds will be via check made out to school.

Applicants must submit the following information:

Complete application.
Two (2) letters of recommendation. Letters should be from persons who can attest to the applicant's academic, community and/or work experience.

Deadline: Applications are reviewed biannually; May 15 and November 15. Failure to submit completed application by deadline will automatically be denied and requested for following application period.

If you have any questions, please call Dr. Bhalani at 321-298-5531 or
Sue Tindall at 321-735-6492.

Allied Health College Students:

*All fields required

Name:

Student Address:

Phone:

E-mail:

Name of College:

Field of Study:

Projected Graduation Date:

Family Income:

Please check the appropriate space below based on your family's adjusted gross income from last year's tax return

Total number of other dependents living at home:
Number of dependents in college:

Have you applied for or been awarded other financial assistance or scholarships? Please explain.

Please indicate any other financial considerations:

Please tell us why you feel you are a good candidate for a DGF Scholarship. (50 words or less)

How do you plan to use the funds if you are awarded a scholarship? (50 words or less)

School and Community Activities: (Include any participation in the Doctor’s Goodwill Foundation.)

Work Activities: (Are you currently employed? Please describe your job and indicate the number of hours you work per week.)

Special Conditions: (Please list any circumstances which may be considered, such as being a medical survivor, having a disability, changing careers, etc.)

Goals: (Please state, in 100 words or less, your career goals and how this scholarship will assist you in obtaining your goals.)

Honors and Awards:

Name of any Doctors' Goodwill Foundation member(s) known to applicant.

Would you be willing to volunteer with the DGF and/or attend the annual Doctors' Expo
held in the Spring.

Yes No