Apply for the Surge Scholarship PLEASE REVIEW ALL ELIGIBILITY REQUIREMENTS BEFORE SUBMITTING AN APPLICATION. DEADLINE: 11:59 PM PACIFIC TIME ON SEPTEMBER 30, 2023 Surge ApplicationFirst NameMiddle NameLast NameGender IdentityChosen PronounsRace and Ethnicity (Select all that apply)American Indian/Alaskan NativeAsianBlack/African AmericanHispanic/LatineMiddle Eastern/North AfricanNative Hawaiian/Other Pacific IslanderBiracial/Multi-ethnicWhiteEmailPhone/MobileCost of Residency ProgramWhich residency scholarship are you applying for?- Select -Rizing Tide Surge ScholarshipHODS and AAMU Residency in EMG ScholarshipAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEducationTell us about your educational history—and your aspirations for residency!Last School AttendedCumulative GPAList any co- or extra-curricular activities you participated in during your time in PT school or as a licensed PT professional. Include community activities and other group memberships.List any awards, honors, or achievements you earned as a PT student or during your PT career. What residency program do you hope to attend? What do you hope to do or accomplish after completing your residency?Essay and Supporting DocumentationShort Essay Questions We want to understand what makes you, well, you! To help us get to know you better, please answer the following questions about your drive and world perspective. Please answer all three questions, and limit each answer to 500 words. Limit each answer to 500 words. What inspired you to become a physical therapist? Fast forward 10 years from now. You are a successful physical therapist and enjoying your career. What have you accomplished so far? What does your life look like? Consider your own identity and its relation to your community. How do you define it? How do your identity and your community ties shape your vision for the future of physical therapy? Three Short EssaysChoose Files Official Transcript Upload your official DPT program transcript here.Official TranscriptChoose Files Acceptance Letter Upload the acceptance letter from the residency program you plan to attend here. Acceptance LetterChoose Files Letters of Recommendation Please upload two letters of recommendation below. Ensure the letters were written by a previous teacher, professor, or industry professional and that they answer the following questions: How do you know the scholarship applicant? What qualities do you see in this individual? Why do you feel this individual should receive this scholarship? Two Letters of RecommendationChoose Files How did you hear about this scholarship?Check the box to subscribe to Rizing Tide's monthly newsletter! (Optional) SubscribeSubmit Application