HSGCF Matching Scholarship Application Test

Our Policy

It is the policy of HSGCF to provide equal opportunities without regard to race, color, national origin, gender, sexual preference, age, or disability.

Request Information

Date of Request (mm/dd/yyyy)(Required)

Amount Requested(Required)

Organization Information

Facility Name

Contact Name(Required)

First Last

Title(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email Address(Required)

Student Information (for statistical purposes only)

Recipient Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Recipient Is:(Required)

Current Employee

High School Student

Prospective Employee

Currently Enrolled in Education Program?

Yes

List area of study:

Est. Education Completion Date (mm/dd/yyyy)(Required)

Name of School(Required)

Total Amount Hospital Funded

Program Type

The education associated with these Matching Scholarship funds have helped me with the following (please check all that apply):(Required)

Employee Retention

Employee Recruitment

Improved Quality of Patient Care

Improved Patient Safety

Briefly describe the ways in which these Matching Scholarship funds have benefited your organization:

Medical Professional and General Liability Insurance

Ancillary Coverage for Health Care Providers / Institutions

HSG Employee Benefits Consortium for MHP Insureds:

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