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Nominate a Veteran Student for Wisconsin Healthcare Education Financial Assistance
This program is only meant for students participating in an undergraduate program.
1.
What is your name?
2.
What is the Veteran student's name?
3.
What is the Veteran Student's Ethnic Background
White/Caucasian
Asian
Native Hawaiian or Pacific Islander
Hispanic or Latino
African-American
Native American
Prefer not to say
Other (please specify)
4.
At which educational institution is the Veteran student enrolled at or attending?
5.
What is the Veteran student's major and/or field of study? (Please note we can only assist with those in a healthcare/medical field of study.)
6.
What is the Veteran student's anticipated graduation date?
7.
What expenses can we assist with covering? (Please note this does not include tuition.)
8.
What is the best way for us to reach you?
Phone Call
Email
Text
Other (please specify)
9.
Please provide your contact information or the Veteran Student's Contact Information.
Name
Email Address
Phone Number
10.
Is there any other information you'd like to share? Do you have additional questions for us before we reach out to you?
Current Progress,
0 of 10 answered
