Thank you for your interest in the Future Forward CPD: Empowering Inclusivity Cohort. Please complete all questions to the best of your ability.

Eligibility Requirements:
-Current undergraduate or graduate student at an HBCU
-An interest in the health professions or education

The deadline to apply is January 20, 2026. If you have any questions, please reach out to lgaeta@acehp.org.

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* 1. Contact Information

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* 2. Name of HBCU institution

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* 3. Program of Study

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* 4. Current GPA

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* 5. Expected Graduation Date (MM/DD/YYYY)
(Note: If you do not know the exact day of your graduation, you may use the first day of the month of your expected graduation)

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* 6. Relevant coursework completed (select all that apply)

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* 7. Which of the following have you participated in? (Select all that apply)

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* 8. Please list any Student Organization(s) you have participated in, including the organization's name, years of service, and your role. Please separate multiple organizations with a semicolon.

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* 9. Please list any Volunteer Work you have participated in, including the organization's name, years of service, and your role. Please separate multiple organizations with a semicolon.

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* 10. Please list any Internship Work you have participated in, including the organization's name, years of service, and your role. Please separate multiple organizations with a semicolon.

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* 11. Please list any Research Project Work you have participated in, including the organization's name, years of service, and your role. Please separate multiple organizations with a semicolon.

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* 12. Please tell us about your leadership experiences and how you made a difference. You might include examples such as student government, healthcare advocacy, campus organizations, or Greek life. (250 words/1250 character max)

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* 13. In 500 words or less, please answer the following question: "Why is it important for healthcare teams to include people from different backgrounds and experiences? Can you think of any examples, either from your own life or from stories you've heard, where having diverse perspectives made a positive difference in a healthcare situation?" (500 words/2500 character max)

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* 14. In 300 words or less, please describe your career goals and how this program aligns with them. (300 words/1500 character max)

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* 15. How familiar are you with the field of continuing education in health professions?

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* 16. Contact Information Name of faculty member providing recommendation

Important: The letter of recommendation should be submitted separately by your recommender. Please note the following instructions:
- Inform your recommender that they should email their letter directly to acehp@acehp.org.
- The email subject line must include your full name and "Future Forward CPD Recommendation".
- The letter should be attached as a PDF or Word document.
- The letter must be received by [Insert Deadline Date] for your application to be considered complete.
- Please ensure your recommender is aware of these instructions and the deadline.

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* 17. I understand that I am responsible for ensuring my recommender submits their letter by the deadline, and that my application will not be considered complete until the letter is received.

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* 18. Please upload your resume/CV. File size limit: 16 MB

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* 19. I confirm that all uploaded documents are accurate and up-to-date.

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* 20. Is there anything else you would like to share with the selection committee?

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* 21. How did you hear about this scholarship opportunity?

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