Scholarship Application

To be considered for a scholarship, student athletes must:

  • Be an athlete on a school-affiliated sports team at a Bellin-supported school
  • Submit a 400-450 word essay on the following:
    1. Why the student athlete deserves this scholarship award
    2. How the student athlete’s achievements align with Bellin’s core values
  • Have TWO professional references the scholarship committee may contact. These may include a teacher (maximum of one), coach (maximum of one), employers, clergy members, political figures, etc.

For each reference, please ask them to complete this reference request form, which includes a letter of recommendation.

Please fill out this application and attach your essay and references.

Essays and references can also be emailed to Hilary.Buruin@bellin.org or mailed to:

Bellin Health Titletown Sports Medicine and Orthopedics
Attn: Hilary Buruin
1970 S. Ridge Rd.
Green Bay, WI 54304

All submissions are due by April 12.

Eligible schools:                                                                                                                                            

Algoma, Bark River Harris (Upper Peninsula), Bay Port, Bonduel, Brillion, Coleman, Gillett, GB East, GB Preble, GB Southwest, GB West, Kewaunee, Lena, Luxemburg-Casco, Niagara, North Central (UP), North Dickinson (UP), Oconto, Oconto Falls, Peshtigo, Seymour, Shiocton, St. Thomas Aquinas Academy, Suring, Wausaukee, West De Pere, Wrightstown


Night of Champions Nomination Form

*all form fields are required

Applicant Name: *
Phone: *
School: *
Grade (if applicable): *
Sports involved in: *
Non-School/Personal Email: *
Name of Bellin Athletic Trainer: *
Parent Name: *
Parent Phone: *
Parent Email: *
Attach a Recommendation: *Only pdf, doc, and docx files are allowed. Please remove all spaces in your file name to ensure proper delivery.
Attach a Recommendation: *Only pdf, doc, and docx files are allowed. Please remove all spaces in your file name to ensure proper delivery.
Attach an Essay: *Only pdf, doc, and docx files are allowed. Please remove all spaces in your file name to ensure proper delivery.