Global Health Future Leaders Scholarship Form

Global Health Future Leaders Scholarship Form

Please Note: 1. All financial assistance will be awarded on the basis of need. There are partial and full scholarship available for 20 Indonesian participants. 2. Scholarships of $50-$500 will be awarded depending on financial need. Please answer the questions below and submitted to www.indo-oh-university.net or email form to: nco@indohun.net Name of Applicants: Occupation: College student Company: Syiah Kuala University Study background: Faculty of medicine GPA: 3.21

Please indicate the amount (out of the full $500 fee) you are able to pay: $100 Reason to participate in the Global Health Future Leaders Program:

Please explain how you believe yourself will get benefit from the Global Health Future Leaders Program:

Please describe your financial need.

Is there anything else you would like us to keep in mind as we consider your scholarship request?