Carol Anderson Scholarship Form

CAROL ANDERSON MEMORIAL LEADERSHIP ACADEMY SCHOLARSHIP

To be eligible for the ASCLS-WA Carol Anderson Leadership Academy Scholarship ($1,000) you must be accepted into the ASCLS National Leadership Academy program and willingly provide one year of service to ASCLS-WA following completion of the Academy Program.
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example@example.com
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Sign here that you understand and are willing to accept this commitment to serve the society. I understand that to I am expected to complete the Leadership Academy Program and provide one year of service if awarded this scholarship or return the scholarship funding to the state.

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Submit a copy of your acceptance letter for the above program (required):*

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This application and letter of acceptance to the Leadership Academy must all be complete and received by December 20, 2021.
Applicant's certification:

My sincere intention at this time is to complete training provided in the ASCLS Leadership Academy Program. In the event that I do not complete the Leadership Academy Program, I understand that the scholarship will become a loan subject to repayment to the American Society for Clinical Laboratory Science-WA.
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Please send an email to Brenda Kochis when you have completed this form. Email is BrenKoch@comcast.net. This will ensure that we process your application as soon as possible.
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CAROL ANDERSON MEMORIAL LEADERSHIP ACADEMY SCHOLARSHIP