To nominate a student from your school, please complete and submit this form electronically by April 20th.
The nominee must be someone who is planning to pursue higher education in the fields of health or human sciences and demonstrates teamwork, integrity, personal responsibility, passion, excellence, and respect - our core values.
We will notify you by April 20th if your student has been selected as a 2018 BlueShield Scholar.
If you have a concern about the deadline or have any other questions, please contact Nicky Chlopecki by email, firstname.lastname@example.org, or phone, 518-220-4863.
*Your nomination is not complete until we receive the student photo and photo release form.
*Please e-mail your signed photo release form to email@example.com.