HSGCF Matching Scholarship Application

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)*

Amount Requested*

Organization Information

Facility Name

Contact First Name*

Contact Last Name*

Title*

Mailing Address*

City*

State*

ZIP*

Phone*

Email Address*

Student Information (for statistical purposes only)

Recipient First Name*

Recipient Last Name*

Mailing Address*

City*

State*

ZIP*

Email Address*

Recipient is:*

Current Employee
High School Student
Prospective Employee

Currently Enrolled in Education Program?

Yes
No

If yes, list area of study:

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

Name of School*

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):*

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:

Contact

Contact

MORE THAN MALPRACTICE INSURANCE

MORE THAN MALPRACTICE INSURANCE

Downloadable Scholarship Application

HSGCF Matching Scholarship Application