Harvey Lillard Scholarship Application Fields marked with an * are required. Please verify that you have checked the “I'm not a robot” checkbox. Ok Page 1/4 Contact Information First Name * Last Name * Address Line 1 * Address Line 2 * City * State * Enter required value Postal Code * Email * Page 2/4 Educational Background Please list all colleges and universities that you've attended below. List in order, with the current college/university first. Put N/A if no college/university attended. Chiropractic College Attending * Chiropractic College Attending Enter required value Keiser University Life Chiropractic College West Life University Northwestern Health Sciences University Logan University Texas Chiropractic College Parker University University of Bridgeport School of Chiropractic Palmer College of Chiropractic - West Palmer College of Chiropractic - Florida Cleveland University - Kansas City D'Youville University National University of Health Sciences Northeast College of Health Sciences Palmer College of Chiropractic - Davenport Southern California University of Health Sciences Sherman College of Chiropractic University of Western States What Quarter/Trimester Are You? * What Quarter/Trimester Are You? Enter required value Tri 5 Qtr 7 Qtr 14 Tri 7 Qtr 5 Tri 3 Tri 2 Tri 10 Qtr 2 Qtr 4 Qtr 10 Qtr 3 Qtr 8 Qtr 6 Qtr 12 Qtr 9 Qtr 11 Qtr 13 Tri 1 Tri 6 Tri 8 Tri 4 Tri 9 Qtr 1 Page 3/4 Extracurricular Activities Please list any/all organizations/clubs that you are currently active in or have been active in within the last 5 years below. List in order with the current first. List N/A if no organizations were served and/or no positions were held. Extracurricular Activities * Organization Name / Year(s) Active/Position Held Extracurricular Activities * Organization Name / Year(s) Active/Position Held Extracurricular Activities * Organization Name / Year(s) Active/Position Held Extracurricular Activities * Organization Name / Year(s) Active/Position Held Extracurricular Activities * Civic/Religious/Community / Year(s) Active/Position Held Extracurricular Activities * Civic/Religious/Community / Year(s) Active/Position Held Page 4/4 Essay Questions Please read each of the questions below and answer them to the best of your ability. All answers should be in essay format using no less than 200 words per question. Essay Questions * Describe a time you had to overcome a significant obstacle in your pursuit of a chiropractic education and how this experience shaped your character. Essay Questions * How do you plan to incorporate diversity, equity and inclusion principles into your future chiropractic practice? Essay Questions * Who is your chiropractic role model and why? Consent to the code of ethics policy * This serves as my personal and truthful statement that I have not been found in violation of the student code of ethics while a student at any chiropractic college, and further give the ABCA Scholarship Committee Permission to verify my statement. Powered By GrowthZone
