Scholarship Student Application

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Testimonials
  • Luis N.

    Very professional, the staff was very nice and helpful in my situation. Glad I made the appointment here because they wasted no time in getting me the information I needed.

  • Robert G.

    You couldn't ask for a better staff. They are courteous, helpful and really know their stuff.

  • Tony D.

    Thank you Doctor Ahlering for giving me the potential for a future. Your leadership and skill is reflected throughout your wonderful caring team who navigated me through this phase of my journey and treated me as if I was one of your own family.

  • John R.

    My recovery exceeded every expectation that I had. After the surgery I was basically pain free and only took 1 Tylenol tablet! I was able to walk at length couple of days after the surgery. I did not even feel weak as one expects after the surgery.

  • Elizabeth Z.

    Very professional staff, I like the rapport that they build with their patients. I took my son in for a procedure and the medical assistants took me under their wings and explained every step of the procedure in detail. I couldn't had chosen a better facility.

  • Russell G.

    I have been treated by Dr. Louie and have nothing but good things to say about it. He is friendly, knowledgeable and will answer all the questions posed. In other words he has good bedside manner.

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Personal/Contact Information
Male
Female
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L
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XXL
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M
L
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XXL
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M
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American Indian/Alaskan Native
Hispanic/Latino
American Asian
Native Hawaiian/Pacific Islander
Asian
Other (Please specify below)
Black
Decline to state
Caucasian/White

Students must be 16 years old before the start of the program in order to participate.

Please choose your first priority for session scheduling:

Session I: July 6th through July 17th
Session II: July 20th through July 31st
I am available to participate in any session
Do you need room and board for Session II? Yes No

**Room and board is ONLY available for Session II.
**Out of state/international participants will be given priority.

High School Information
Emergency Contact Information
Are either of your parents an employee of the University of California? Yes No
Financial Information
Is the applicant’s family receiving state/federal assistance? Yes No
Has the applicant’s family ever received state/federal assistance? Yes No
Will the applicant be able to participate (paid tuition) if a scholarship is not awarded? Yes No

Personal Responses

These short essays will help to give us some insight to your personality, interests and need for scholarship funds.

1. Please describe why you would like to participate in the UC Irvine Heath Summer Surgery Program. (please remember these are “short” essay questions)

2. Please list the top 5 most important activities, hobbies, or special experiences you’ve had.

3. Choose your favorite/most important of the above activities and describe what you have gained from this experience and how you have or will use this to make an impact on others.

4. Please describe a challenge or hardship that you have overcome and what you have learned about yourself from this experience.

5. Please tell us what you hope to gain from attending this program and how receiving a scholarship will have a direct impact on you.

By typing my name below, I certify that all the information provided in this application is correct:

Nothing but the absolute best in patient care & treatment.
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UC Irvine Health Department of Urology

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