Scholarship Application

Our Scholarship Program and application will be available soon.

Scholarships are awarded based ONLY on the information provided on this form. 15 Scholarships are available for each cohort, ranging from 25-100% of tuition and fees. Books and supplies remain the responsibility of the student.

Prefix

Legal First Name *

Middle Name

Last Name *

Phone *

Email Address *

Have you already submitted an Application to our Midwifery Program? *YesNo

Recent Paystub

No file chosen

Most Recent Tax Return

No file chosen

Explanation of Benefits from Public Service Agency or 501(c)3 Charitable Agency

No file chosen

Other Proof of Income

No file chosen

Why are you applying for our Midwifery Diploma Scholarship program? *

Do you Identify as a member of a protected minority group? *YesNoThis includes disability, race, ethnic group, religion, sexual orientation, gender identity, veteran status.

If yes, Please self-Identify

In a Minimum of 500 words, please explain how you will use your midwifery education to improve the lives of your clients. *

Consent *

I Understand that the information I have provided will be used to determine my eligibility for a scholarship ranging from 0-100% of the cost of tuition and fees, including needs based, achievement and identity based scholarships provided by the Midwifery Institute to it's students.

Consent *

I Understand that failure to provide all of the information requested may result in my application for scholarship funds being denied, regardless of my actual qualifications for scholarships, as the above information is the only information that will be used to determine my eligibility.

Consent *

The above information is accurate under penalty of dismissal from all Midwifery Institute programs and civil suit for the balance of any aid I am awarded.

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