Scholarship Form

Past Scholarship Recipients

Tristan Benedict

Kamil Brzozowski

Carson Schmeck

Nancy Theinert

Michelle Jaskula-Dybka

Matthew Zimmerman

Logan Abrams

Alysha Williams

Kathryn Mettenburg

Chelsea Furnish

Sean Clingan

Matthew Mosca

Past Scholarship Recipients

Tristan Benedict

Kamil Brzozowski

Carson Schmeck

Nancy Theinert

Michelle Jaskula-Dybka

Matthew Zimmerman

Logan Abrams

Alysha Williams

Kathryn Mettenburg

Chelsea Furnish

Sean Clingan

Matthew Mosca

Michigan Perfusion Society Scholarship Form

Dan Zwada Scholarship

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Program Position*

Didactic

Clinical

One Year Program

Program Director*

Program Director Email*

Program Director Phone*

Program Director's Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list below your Educational Achievements since High School*

Please list below your Community Achievements since High School*

Please list below any Medical Achievements since High School*

Are there any financial hardships of relevance during your Perfusion Education*

Yes (please explain below)

Please explain your financial hardship, if you answered yes above

Essay Questions: Please type the answers below. Responses need not to be lengthy, but rather content critical. Please site any references you might have used during your discussion: As a current student in a Perfusion Educational Program, what was your motivating factor for a career path in perfusion? Why Perfusion, Why Me?*

Given a review of the historical aspects of perfusion during your education, what do you see as the future of the profession, and specifically as a Perfusionist within the medical field, what your role will encompass?*

Please submit a current Curriculum Vitae*

Drop files here or

Max. file size: 300 MB.

NOTE :*

If selected for this award would you be able to attend the summer Michigan Perfusion Society meeting August 17th, 2024. If your are unable to attend, it will be necessary to provide an acceptance video that we can play during the meeting to introduce you to our society. (Format must be playable on a windows laptop)

Yes