Current Health Scholar Forms

Below are forms for current Scholars. Please submit all forms to the appropriate Leader at your site or to your Program Manager.

Change of Information

Hours Audit

Incident Report

Leave of Absence

Letter of Recommendation

Program Completion

Site Transfer

Withdrawal Request

  • If you are considering withdrawing from the program, please reach out to your Program Manager prior to filling out and submitting this form to them. There are often many things we can do to ensure you have a more positive program experience, or find a way that you can meet the core program requirements with a busy schedule. Please also note that this is a request form, and any withdrawal request will only be processed in good standing after a Scholar has completed the exit survey and submitted their site badge. Only Scholars who withdraw in good standing will be eligible for an hours audit.

Leadership Team Application

Executive Leadership Team Application

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