Scholars for a Healthy Oregon Initiative Application – Student Resource



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Scholars for a Healthy Oregon Initiative
Application – Student Resource

This fillable word document has been created as a resource to help you review the questions within the application and craft your answers before applying online. To apply for the Scholars for a Healthy Oregon Initiative please go to www.ohsu.edu/healthyoregon and click on Apply Now!

Thank you for your interest in the Scholars for a Healthy Oregon Initiative Funding. The initiative is intended to address issues related to high tuition and the shortage of healthcare professionals in Oregon's rural and underserved communities. A full list of the obligations for this funding are listed below.


Funding is available to applicants who are admitted to select academic programs at OHSU: Doctor of Medicine (MD), Doctor of Dental Medicine (DMD), Master of Physician Assistant Studies (MPAS), or Masters of Nursing (MN) in Nurse Anesthesia, Family Nurse Practitioner, Nurse Midwifery, or Psychiatric Mental Health Nurse Practitioner.

Funding priority will be given to Oregon residents or applicants who can demonstrate Oregon Heritage (policy number 0-02-1012) under OHSU admissions criteria. Further priority consideration will be given to applicants who are:




  • Students who lived and/or graduated high school in a rural location or underserved community or who graduated from one of the four regional Oregon University System institutions (Eastern Oregon University, Oregon Institute of Technology, Southern Oregon University or Western Oregon University)



  • First generation college students



  • Individuals from a diverse or under-represented community

Additional information on this initiative can be found in the program description at www.ohsu.edu/healthyoregon.

This application includes demographic data, as well as short and long answer essay questions. You may save and return to your work later if you are not able to complete in one session. We encourage you to answer all questions. Leaving questions blank (except for questions relating to gender, ethnicity and race) may constrain the selection committee from conducting a thorough review of your application.

By submitting this application, you authorize the OHSU School of Medicine, Dentistry, Physician Assistant or Nursing to release the information you provided on your admissions application to the Scholars for a Healthy Oregon Initiative Selection Committee. If you have any questions, please contact Anna Tupper at tupper@ohsu.edu.

I have read and understand the program obligations ☐True

for the Scholars for a Healthy Oregon Initiative funding. ☐False




Demographic Information

Last Name Click here to enter text.
First Name Click here to enter text.
Address Click here to enter text.
City/Town Click here to enter text.
State Click here to enter text.
ZIP/Postal Code Click here to enter text.
Email Address Click here to enter text.


Phone Number Click here to enter text.
Application Service Number (this is your CASPA, Click here to enter text.

AMCAS, AADSAS or Nursing CAS). If you do not have an

Application Service Number, please type "n/a"


What is the status of your application at this time? (check only one box)


OHSU School of Dentistry (DMD) OHSU School of Medicine (MD) OHSU Masters of Physician



Assistant Studies

OHSU School of Nursing: Midwifery

OHSU School of Nursing:
Anesthesia

OHSU School of Nursing: Psychiatric Mental Health Nurse Practitioner

OHSU School of Nursing: Family

Nurse Practitioner
Applied no decision yet On Waiting List Admitted

☐ ☐ ☐


☐ ☐ ☐

☐ ☐ ☐


☐ ☐ ☐

☐ ☐ ☐


☐ ☐ ☐

☐ ☐ ☐


Have you, or will you, apply for any of the following ☐National Health Service Corp Scholars programs (check all that apply) ☐Military Scholarship/Obligation

☐Other program with obligated service after training
Program Name Click here to enter text.
Did you graduate from a high school in Oregon? ☐Yes

☐No
Name/Location (city and state) of the high school Click here to enter text.

from which you graduated?
Did you spend at least 2 years in this high school ☐Yes

before graduation? ☐No



Which academic degrees will you hold at the time of matriculation to OHSU? (check all that apply)



Bachelor degree Master degree Doctoral degree Other

Obtained from an Oregon college Obtained from a Non-Oregon college or or University or University

☐ ☐


☐ ☐

☐ ☐


☐ ☐




Other (please specify) Click here to enter text.
Other (please specify) Click here to enter text.
Name of the institution where you obtained your Click here to enter text.

Bachelor degree


Did you spend at least 2 years at this college or ☐Yes university before graduation? ☐No
Community Size: what is the population of the ☐Rural-less than/not within 10 miles of city with principal place you lived in during childhood? 40000

☐Mid-sized City-40,000 - 99,999

☐Large City-100,000-999,999

☐Urban->1,000,000

☐No Response
Do you believe that the area you lived in during ☐Yes childhood was medically underserved? (Defined as an ☐No

area with a high percentage of the population below ☐Unknown

the poverty level; a high percentage of the ☐No Response population that is elderly; a high infant mortality

rate; and/or a lack of available primary care physicians)


Highest level of education attained by either ☐No formal education parent/guardian? ☐Kindergarten - 8th grade

☐High school graduate/GED

☐Some college

☐Bachelor degree

☐Master/Doctoral degree

☐Unknown


☐No Response

Would you identify yourself as being an ☐Yes

underrepresented minority? ☐No
If you identify as an underrepresented minority,

please provide information in the space provided

(otherwise, enter "n/a") Click here to enter text.


While you were growing up, did you experience any of the following types of adversity?


Economic Educational Ethnic/Cultural Family

None Mild Moderate Severe No Response
☐ ☐ ☐ ☐ ☐

☐ ☐ ☐ ☐ ☐

☐ ☐ ☐ ☐ ☐

☐ ☐ ☐ ☐ ☐




If you indicated that you have experienced adversity,

please describe the nature of the adversity

(otherwise, enter n/a): Click here to enter text.


Legal state of residence when applying to OHSU: ☐Oregon

☐Other
Other (please specify) Click here to enter text.


Does one or more of your parents/guardians currently ☐Yes reside in Oregon? ☐No

Short Essay Question (max. 250 words)

Where do you intend to practice in the future?

Click here to enter text.

Long Essay Question #1 (max. 1000 words)
Describe the population you plan to serve and what attributes and experiences you have had that will contribute to meeting the needs of that population?

Click here to enter text.



Long Essay Question #2 (max. 1000 words)
The Scholars for a Healthy Oregon Initiative funding was created to address issues related to high tuition and the shortage of healthcare professionals in Oregon's rural and under-served communities. How will you contribute to meeting the goals of this program?

Click here to enter text.



The following questions are for statistical information only and not required for your application to the Scholars for a Healthy Oregon Initiative funding to be considered.

Gender ☐Male

☐Female

☐Other
What is your ethnicity? ☐Hispanic or Latino



☐Not Hispanic or Latino
Select one or more races to indicate what you ☐American Indian or Alaska Native consider yourself to be: ☐Chinese

☐Filipino

☐Indian

☐Korean


☐Vietnamese

☐Asian Other

☐Black or African American

☐Native Hawaiian or other Pacific Islander

☐Eastern European

☐Middle European



☐White Other



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