Michael J Miller Scholarship Program

PRO TIPS:

Please fill out the following form carefully and completely, noting all of the required fields.
All email addresses must be in valid xx@xx.xx format.
16 MB limit on all file uploads.
Your nomination is only submitted once you have reached the screen with the green top bar saying “Thank you for taking this survey”.
Files and supplemental materials may be emailed to awards@aami.org.
Please direct any questions or support needs to awards@aami.org.

Contact Information:

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* 1. Name:

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* 2. Company/Affiliation:

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* 3. Mailing Address:

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* 4. Phone Number:

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* 5. Email Address:

Education and Employment:

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* 6. Employment History:

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* 7. Undergraduate Institution:

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* 8. Graduate Institution:

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* 9. College Accreditation Agency:

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* 10. Cumulative GPA:

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* 11. Expected Date of Graduation:

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* 12. List Degree Type:

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* 13. Please enter your name verifying this information is true to the best of your knowledge:

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* 14. Select Your Major:

Engineering, Health Systems

Engineering, Engineering Technology, or Other

Biomedical equipment technician student

Other (please specify)

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* 15. Briefly describe how you are financing you education:

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* 16. Essay:

Upload your 500-700 word essay explaining how you view yourself fitting into the profession and describing your evidence of academic excellence.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 17. Transcript:

Upload your most recent transcript from an accredited college, or a high school transcript and documentation of college admission into the relevant program.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 18. 1st Letter of Recommendation:

Upload your letter of recommendation from professional or academic contacts.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 19. 2nd Letter of Recommendation:

Upload an additional letter of recommendation from professional or academic contacts.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File