Intern Scholarship

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Graduate School*

Graduate School GPA*

Graduating or Graduation Year*

Mental Health Internship and Dates

Registered Mental Health Counselor Intern Number

Active Member of GMHC? If so, year joined*

Any GMHC Board Position or Committee?

Scholarship Description

Please explain your specific need and how you would utilize the scholarship funds:*

Please select from a topic below and submit a 500 word essay with this application

Would you like to upload or copy & paste your essay?*

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I understand that applying for this competitive micro scholarship does not assure that I will be awarded all or part of the amount that I am requesting. I further understand that a limited number of scholarships will be available during the 2019 calendar year. I understand that I am eligible for only one GMHC micro scholarship during a two year period. I affirm the information that I am providing on this application is true and correct. (Allow 45 days for a response.)

Consent

I agree to the consent policy.

I agree that if I am chosen as a winner for the GMHC scholarship. GMHC can publicly announce my name as a winner and promote my name and story as a scholarship recipient from GMHC.

Electronic Signature*

First Last

Date*

Scholarship Application