🎓 BRIDGING HealthCARE CoMMUNITIESLicensing Scholarship Application Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred Pronouns: * Graduation Date: * Institution Attended: * Degree Earned: * Field of Study: * Which licensing or certification exam are you preparing for? (Select all that apply) * USMLE Step 1 or Step 2 CK (MD/DO) – $1,020 per exam NCLEX-RN or NCLEX-PN (Nursing) – $200 exam fee; additional state licensure fees vary NAPLEX (Pharmacy) – $620 total NPTE (Physical Therapy) – $485 exam fee NBCOT (Occupational Therapy) – $500 exam fee; state licensure fees vary INBDE (Dental) – $680 exam fee Other Have you taken any of these exams? Yes No If yes, please specify which exam(s), your preparation methods, and resources used: What is the total estimated cost for your licensing or certification process? Include exam fees, preparation materials, travel, and any additional expenses. * Have you encountered financial challenges in affording these costs? Please describe any obstacles and how they have impacted your preparation. Are you currently employed or have you worked to support your educational expenses? Yes No If yes, please describe your employment and how it contributes to your exam-related expenses: How would receiving this scholarship impact your journey toward a healthcare career? What motivates you to pursue a career in healthcare, and how do you plan to contribute to your community in this role? If you are not awarded the full scholarship amount, what is the minimum support that would still make a significant difference for you? Is there any additional information about your financial situation or academic journey that you would like to share? Thank you!
