Apply for the Surge Scholarship PLEASE REVIEW ALL ELIGIBILITY REQUIREMENTS BEFORE SUBMITTING AN APPLICATION. DEADLINE: 11:59 PM PACIFIC TIME ON October 9, 2024 Surge ApplicationFirst NameMiddle NameLast NameGender IdentityChosen PronounsRace and Ethnicity (Select all that apply)American Indian/Alaskan NativeAsianBlack/African AmericanHispanic/LatinxMiddle 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) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican 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 RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi 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!DPT Program 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 plan to attend? What do you hope to pursue or accomplish after completing your residency?Essays 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. Limit each answer to 500 words and submit all three essays as one PDF file. Why did you choose to attend a residency program, and what is the main goal you wish to accomplish during your residency? Reflect on your experience in your DPT program. What do you know now that you wish you knew as a new DPT student? What advice would you give to first year DPT students? How do your ethnic background, culture, and community ties shape your vision for the future of physical therapy? Three Short EssaysChoose File 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 File Letters of Recommendation Please upload two letters of recommendation below in PDF format. 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? Letters of recommendation may also be sent directly to [email protected]. Please make sure that your name is placed in the subject line of the email.Two Letters of RecommendationChoose Files How did you hear about this scholarship?Eligible students who apply for a Rizing Tide scholarship are automatically enrolled in Rizing Tide's Employer Connect program. This free-to-participate program connects students with employment opportunities post graduation. Check the box to complete your application. I have read and understand the above information. Check the box to subscribe to Rizing Tide's monthly newsletter! (Optional)Submit Application