Application for High School Students

If you are a high school junior or senior in Montana who has a GPA of 2.5 or above and want to go to college to pursue a health related career, are invited to apply to Hopa Mountain’s Health Scholars of Promise program. This college preparation program will provide accepted students with training, mentoring, and support services to help them apply to the colleges and universities of their choice, as well as expose them to various health education paths and health career options.

Student's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number

(###)

###

####

Secondary Phone Number

(###)

###

####

Student's Email Address

Date of Brith

YYYY

Most Recent Grade Level Completed

Overall GPA as of latest semester or school year

Tribal Affiliation(s), if any (optional)

Other Identities (optional)

Example: Latino/a, etc.

Do you consider yourself a foster child, homeless, or in kinship care? (Optional)

PARENT/GUARDIAN INFORMATION

Primary Guardian Name

First Name

Last Name

Primary Guardian Phone Number

(###)

###

####

Guardian's Email

STUDENT RESPONSES

These questions are just so we can get to know you better.

Please List Any Extracurricular Activities and Leadership Positions

(Any clubs, organizational involvements, volunteer services, paid jobs, or cultural activities)

Why is health important to you?

1-2 paragraphs

Tell us more about what type of health-related work you are interested in.

1-2 paragraphs

Why do you want to participate in the Health Scholars of Promise program?

1-2 paragraphs

If you are selected to participate in Health Scholars of Promise, would you be able to participate in meetings throughout the next year to prepare for college?

Yes

Anything else you'd like us to know?